Presented  by 
Mrs.   Hunter 


COLLEGE  OF  OSTEOPATHIC   PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


THERAPEUTICS 


OF 


DRY  HOT  AIR 


BY 

CLARENCE   EDWARD   SKINNER,    M.    D.,    LL    D. 

Physician  in  Charge  of  the  Newhope  Private  Sanitarium,  New  Haven,  Conn.  ; 
Editor  of  the  Archives  of  Physiological   Therapy  ;   Formerly  Professor  of 
Thermotherapy  at  the   New  York  School  of  Physical   Therapeutics  ; 
Member  of  the  American  Medical  Association,  American  Electro- 
Therapeutic  Association,  American   Roentgen   Ray   Society, 
American  Association    for  the  Advancement  of  Science, 
Yale  Medical  Alumni  Association,  Connecticut  Medi- 
cal  Association,    New   Haven   County   Medical 
Society ;     Associate     Fellow     New     York 
Academy  of  Medicine  ;  Foreign  Mem- 
ber Societe    Franjaise    d'Electro- 
therapie  et  de  Radiologie,  etc. 


SECOND  EDITION 
ENLARGED  AND    THOROUGHLY  REVISED 


NEW  YORK 

A.    L.   CHATTERTON   &   CO. 

PUBLISHERS 


GOB  465" 


COPYRIGHT,  1907, 

BY 
CLARENCE  EDWARD  SKINNER. 


DEDICATED 
TO   THE    MEMORY   OF    THE   LATE 

DR.    HEMAN   BANGS  SMITH, 

WHOSE     PERSONALITY,    RICH    IN   THE    UNCONSCIOUS   NOBILITY   OF   TRUE 
MANHOOD,  AND   OVERFLOWING    WITH    THE    MILK    OF   HUMAN- 
KINDNESS,      WILL      ALWAYS     BE     RECALLED     WITH 
DEEP    AFFECTION     BY    THE    AUTHOR. 


PREFACE   TO    SECOND    EDITION. 

FOR  several  years  past  the  writer  has  felt  that  new  forces 
were  coming  to  the  front  in  the  therapeutical  world,  that  were 
destined  in  a  few  years  to  revolutionize  the  current  methods 
of  treating  many  disease  processes  and  to  greatly  increase  the 
inherent  efficacy  of  others;  we  refer  to  the  so-called  "physio- 
logical "  forces,  heat,  cold,  electricity,  the  various  forms  of 
radiant  energy,  etc.  The  first  edition  of  this  book  was  written 
for  the  purpose  of  bringing  before  the  profession  one  of  these 
forces  which  the  writer's  experience  had  convinced  him  was 
destined  to  become  one  of  the  foremost  in  therapeutical  im- 
portance and  utility,  and  which  was  known  and  understood  by 
but  a  very  small  number  of  medical  men.  The  conviction  that 
a  book  upon  dry  hot  air  would  fill  an  urgent  want  has  been 
fully  confirmed  by  the  manner  in  which  the  first  edition  was 
received  and  which  has  encouraged  the  author  to  omit  no  pains 
in  order  that  this,  the  second  edition,  shall  be  complete  in 
every  respect. 

Although  the  general  plan  and  scope  of  the  work,  as  em- 
bodied in  the  first  edition,  remain  the  same,  yet  the  addition 
of  matter  pertaining  to  many  small  but  important  details,  and 
several  illustrations  which  were  needed  for  complete  elucida- 
tion of  the  text,  has  increased  somewhat  the  size  of  the  volume ; 
as  the  subject-matter  has  been  entirely  rewritten  and  rear- 
ranged, however,  this  increase  in  size  does  not  interfere  with 
accessibility  to  the  contents,  and  accessibility  is  still  further 
facilitated  by  the  exhaustive  character  of  the  table  of  contents 
and  the  index. 

The  plan  of  mentioning  briefly  the  other  remedial  measures 
which  it  is  advantageous  to  employ  in  conjunction  with  dry  hot 
air,  has  also  been  retained.  As  stated  in  the  preface  to  the  first 
edition,  this  agent  "  is  not  an  universal  panacea.  It  is  simply 
a  rational  therapeutic  element  which,  alone  or  in  combination 


27043 


vi  Preface  to  Second  Edition. 

with  other  remedial  agents,  will  increase  greatly  our  power 
to  overcome  pathological  processes.  In  order  to  appreciate  its 
true  value,  therefore,  it  must  be  viewed  in  its  various  thera- 
peutical relations,  not  alone." 

At  the  suggestion  of  many  who  have  perused  the  first  edi- 
tion, a  number  of  additional  case  reports  have  been  introduced 
to  illustrate  and  demonstrate  statements  made  in  the  text.  The 
results  obtainable  with  dry  hot  air  are  sometimes  so  magical 
as  to  tax  uninstructed  credulity  to  the  utmost,  hence  these 
illustrative  cases  have  been  selected,  as  far  as  possible,  from 
among  those  patients  who  are  now  alive  and  accessible ;  there  is 
no  evidence  so  convincing  as  that  furnished  by  one's  own 
senses. 

His  experience,  since  the  first  edition  was  published,  has  not 
led  the  author  to  change  his  opinions  on  any  of  the  cardinal 
principles  theiun  set  forth,  but  has  resulted,  as  suggested 
above,  in  some  amplification  and  development  of  those  princi- 
ples :  the  description  of  these  contained  herein  he  believes  adds 
greatly  to  the  value  of  the  present  edition  as  compared  with 
the  previous  one. 

He  desires  hereby  to  thank  those  who  have  by  apt  sugges- 
tion assisted  him  in  bringing  the  work  to  its  present  degree 
of  usefulness,  and  to  express  the  hope  that  this  volume  will  be 
as  helpful  to  his  colleagues  in  the  future  as  he  has  been  many 
times  informed  the  previous  one  has  been  in  the  past. 

C.  E.  S. 

NEW  HAVEN,  CONN.,  March,  1905. 


PREFACE   TO    FIRST   EDITION. 

DRY  superheated  air  as  a  therapeutical  measure  has  now  been 
before  the  medical  profession  for  several  years,  yet  as  far  as 
the  average  practitioner  is  concerned  it  is  still  a  new  and  un- 
known quantity.  Even  the  latest  text-books  dismiss  it  with 
but  a  mention,  and  that  only  in  connection  with  two  or  three 
pathological  processes.  This  general  ignorance  of  the  agent 
is  to  be  deplored,  as,  when  skillfully  administered,  it  is  one 
of  the  most  potent  and  useful  at  our  command  and  applicable 
to  many  disease  conditions  wherein  the  ordinary  methods  of 
treatment  are  unsatisfactory. 

In  the  following  pages  is  set  forth  what  has  been  ascertained 
in  reference  to  dry  hot  air  therapeusis  up  to  the  present  time. 
It  has  been  considered  desirable  to  mention  briefly  the  other 
remedial  measures  which  it  is  advantageous  to  apply  to  differ- 
ent conditions  in  combination  with  dry  hot  air,  because  this 
agent  is  not  an  universal  panacea.  It  is  simply  a  rational  thera- 
peutic element  which,  alone  or  in  combination  with  other  rem- 
edial agents,  will  increase  greatly  our  power  to  overcome  patho- 
logical processes.  In  order  to  appreciate  its  true  value,  there- 
fore, it  must  be  viewed  in  its  various  therapeutical  relations, 
not  alone.  Where  necessary  to  elucidate  the  manner  in  which 
dry  hot  air  produces  its  effects,  the  pathological  features  in- 
volved in  the  condition  under  consideration  have  been  briefly 
noted. 

Many  of  the  failures  to  secure  satisfactory  results  with  dry 
hot  air  have  been  due  to  the  fact  that  it  has  been  called  upon 
to  influence  pathological  conditions  which  were  not  amenable 
to  its  physiological  action;  others  more  numerous  still  have 
been  due  to  faulty  technique  in  its  administration.  These  sub- 
jects, therefore,  have  been  treated  at  some  length. 

It  is  not  to  be  expected  that  every  general  practitioner  will  or 
can  become  a  dry  hot  air  expert,  but  every  physician  should  at 


viii  Preface  to  First  Edition. 

least  understand  the  principles  of  its  application  and  the'clinical 
results  derivable  therefrom,  in  order  that  he  may  be  able  to 
decide  intelligently  when  his  patient  will  be  benefited  by  its 
use.  If  he  does  not  care  to  undertake  its  actual  administration 
he  can  send  his  patient  to  someone  who  is  an  expert. 

Finally,  too  much  must  not  be  expected  of  dry  hot  air,  or 
any  other  one  measure.  It  will,  alone  and  unaided,  cure  some 
disease  conditions;  others  will  require  all  the  therapeutical 
resources  at  our  command;  and  in  still  others  even  all  that 
we  have  will  not  suffice  to  produce  a  cure.  Its  powers,  how- 
ever, are  exerted  in  directions  in  which  remedial  agents  hith- 
erto known  have  been  very  deficient;  its  addition  to  the 
treatment  results  in  benefit  to  many  patients  who  would  fail 
to  improve  under  other  measures  alone,  and  its  adoption  into 
our  armamentarium  enables  us  to  increase  by  a  large  percent- 
age the  sum  total  of  our  power  over  disease.  Any  agent 
ppssessing  these  attributes  is  entitled  to  respect  and  study.  Dry 
hot  air  exhibits  them  in  an  eminent  degree. 

CLARENCE  EDWARD  SKINNER. 

NEW  HAVEN,  CONN.,  October,  1902. 


CONTENTS. 

CHAPTER  I. 

APPARATUS. 

PAGE 

Outfit •  . .      .      ;     .      .      i 

Construction i 

THE  BODY  APPARATUS 2 

Structural  Modification  of  Body  Apparatus,      .         .         .         .2 

THE  GENERAL  LOCAL  APPARATUS, 12 

THE  KNEE  APPARATUS .   13 

Internal  distribution  of  heat .'       ;       13 

Elimination  of  moisture,  .  •       .         .         .         .         ...         .        [4 

Fire-proof  cloth  fittings, '.'. .  *~  '       15 

Source  of  heat, •   .  •      .        16 

Special  chair  for  local  application  to  shoulder,          .         ...       \~j 
Location  of  apparatus,      .         .         .  ^  .         .         .         .         .18 

DEVICES    FOR   APPLYING    DRY    HOT    AIR    TO    THE    OPEN 

CAVITIES  OF  THE  BODY 18 

External  auditory  canal,.  .         .         .         .         .         .         .19 

The  alcohol  heater, 19 

The  gas  heater .         .20 

The  electric  heater •  ,         .       21 

CHAPTER   II. 
PHYSIOLOGICAL  ACTION. 

Differentiation  from  other  methods  of  administering  heat,  .  .  23 
Electric  arc  and  incandescent  light  baths.  .  .  .  .  -23 
Hydrotherapy,  .  .  .  .  .  .  .  .  -24 

Varieties  of  application  and  nomenclature, 25 

GENERAL  APPLICATION,  25 

Body  temperature,  .........       25 

Pulse, 25 

Respiration,     .         .         .         .         .         .         .         .         .         .25 

Skin 26 

Blood, 26 

Urine 26 

Variations  in  extent  of  influence  induced,         ....       26 


;  Contents. 

PAGE 

Subjective  phenomena,    ........  27 

Rationale  of  action,          ........  27 

Sphere  of  action, 28 

LOCAL  APPLICATION 28 

Elements  of  physiological  action,     ....  .28 

Temperature  elevation  of  part  treated, 28 

Reflex  effects, 29 

General  body  temperature  and  pulse, 30 

Sphere  of  action, 3° 

Summary  of  Physiological  Influences,          .....  30 

General  application,          ........  3° 

Local  application,             ........  31 

Clinical  applicability, 31 

Analogies,            . 32 

Fallacies,     .                  32 

As  to  identity  of  the  influences  exerted  by  hot  and  cold  appli- 
cations,    ..........  32 

As  to  identity  of  the  effects  producible  with  dry  hot  air  and 

hydrotherapy, 37 

As  to  the  rationale  of  its  physiological  influences,    ...  39 

As  to  permanence  of  results, 40 


CHAPTER  III. 
TECHNIQUE. 

Methods  of  preparation, 42 

LOCAL  APPLICATION -43 

Preparation 43 

Arms  and  legs 43 

Knee,  . 44 

Shouklei , 56 

Hip,  57 

Abdomen, 57 

Chest  wall  and  lumbar  region,        ......       57 

Amount  of  wrapping  necessary,     ......       58 

Apparatus, .  .58 

Administration,  .........  58 

Duration  and  Intensity  of  se'ance, 75 

After-care,      .         .         .         .         .         .         .         .         .         -75 

External  Auditory  Canal 75 

Management  of  the  apparatus, 75 

Preparation  of  the  patient, 76 


Contents.  xi 

PAGE 

Administration, 75, 

GENERAL  APPLICATION,    '. 76 

Preparation 76 

Administration, 7- 

Prevention  of  accidents, 81 

Intensity  and  duration  of  seance 83 

After-care,       ........  8c 

In  Genera], 

Frequency  of  administration 86 

Intermissions  in  treatment,   .                  ....  86 

Burns 87 

Contra-indications 87 

Atheroma  and  irregular  pulse,           ....  88 

Valvular  heart  lesions, 88 

Pyrexia 88 

Hyper-pyrexia ^ 

Local  infective  or  inflammatory  foci, ox> 

CHAPTER  IV. 

SPRAINS. 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,  92 

Local  Application o2 

General  Application 02 

Rationale  of  Thermotherapy 02 

Pathology  and  Symptomatology, 93 

Therapeutic  indications, 02 

Local  application, gz 

General  application o. 

Illustrative  Case 04 

Treatment, Q, 

Local  dry  hot  air  application 0,4 

General  dry  hot  air  application, or 

Additional  remedial  measures oc 

CHAPTER  V. 

RHEUMATISM. 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,  97 

Local  Application, 97 

General  Application 97 

Rationale  of  Thermotherapy yj 

Etiology,  pathology,  and  symptomatology,  ..... 


xii  Contents. 

PAGE 

Therapeutic  indications 99 

Local  application 99 

Is  salicylic  acid  a  specific  for  rheumatism  ?  101 

General  application,    .         .         .         .         .         .         .         .         .105 

Diagnosis,      .         . 105 

Illustrative  Case's, 106 

Acute  rheumatism .106 

Chronic  rheumatism.  .         .         .         .         .         .         .         .109 

Treatment,     .         .         .         .         .         .         .         .  .         .      1 10 

Clinical  forms  of  rheumatism, i  10 

Complications,     .         .         .  .         .         .         .         .         .ill 

Local  dry  hot  air  application,       .         .         .         .         .         .         .      i  1 1 

After-care, .         .         .112 

General  dry  hot  air  application, .112 

Additional  remedial  measures 113 

Diet 113 

Drugs 113 

Aspirin, 113 

Salicin, 114 

Sodium  salicylate, •      .  i  14 

Salophen, 114 

Methyl  salicylate, '      .         .         .114 

Alkalies,       .         .......         .         .      i  14 

Salines,         .         .         .         .         .         .         .         .         .         .115 

Electricity, .         -115 

The  static  current,       . 115 

The  magnetic-induced  current 115 

The  Voltaic  current, .  115 

Chronic  rheumatism,      .'.*..  1 16 

Treatment, i(6 

CHAPTER  VI. 
LOCAL  SEPTIC    INFECTION. 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,  117 

Local  Application,  ...  117 

General  Application,  ...  117 

Rationale  of  Thermotherapy,  i  rg 

Etiology  and  pathology,  ...  i  [8 

Therapeutic  indications,  .  ,  m 

Local  application ,,9 

General  application,  .  ,2I 

Illustrative  Cases,            .  I22 


Contents.  xiii 

PAGE 

Treatment, .126 

Local  dry  hot  air  application,      ."        .         .         .  '"  .         .         .126 

General  dry  hot  air  application,         • 127 

Additional  remedial  measures 128 

Diet 128 

Drugs,     .         .         ... 128 

Operative  interference, 128 

Electricity 128 

CHAPTER  VII. 

PNEUMONIA. 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,  130 

Local  Application, 130 

General  Application,  .  . 130 

Rationale  of  Thermotherapy 131 

Etiology  and  pathology,  . 131 

Therapeutic  indications .  .134 

Local  application,       •-.--.         .         .         .         .         .         .  135 

General  application,  .........  138 

Illustrative  Cases,      .        .• 138 

Treatment,  ...........  144 

Local  dry  hot  air  application 144 

After-care, 144 

General  application,  .  .  .  .  .  .  .  .  .  147 

Heart  failure, 148 

Additional  remedial  measures,       .         .         .        .         .        .         .148 

Drugs, .  .  .  148 

CHAPTER  VIII. 

ALBUMINURIC   NEPHRITIS  (BRIGHT'S   DISEASE). 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,  150 

Local  Application, 150 

General  Application,  .  .  .  .  .  .  .  .  .  1 50 

Rationale  of  Thermotherapy 150 

Etiology, 150 

Symptomatology  and  pathology .  .151 

Nature  of  specific  toxin, 153 

Therapeutic  indications .  .156 

General  application,  .  . 157 

Illustrative  Cases 157 

Treatment, 166 


xiv  Contents. 

PAGE 

General  dry  hot  air  application,        .         .         .         ....         .     166 

Additional  remedial  measures,          .......     167 

Diet, .167 

Clothing, 167 

Drugs,          ...         .         . 167 

Electricity 167 

CHAPTER  IX. 

ARTHRITIS   DEFORMANS. 

Modifications  of  Clinical  Conditions  producible  with  Dry  Hot  Air,     169 
Local  Application,       .........     169 

General  Application, 169 

Rationale  of  Thermotherapy,  .         .         .         .         .         .         .169 

Etiology  and  pathology,      .         .         .         .         .         .         .         .170 

Neural  theory,          .         .         .         .         .         .         .         .         .170 

Rheumatism  as  a  causative  factor,  .         .         .         .         .172 

Symptomatology, .         .173 

Pain .173 

Body  temperature, 174 

Nervous  system,       .         .         .         .         .         .         .         .         .174 

Muscular  atrophy, 173 

Muscular  spasm,      .........     175 

Skin 175 

Albuminuria, .         .176 

Joint  appearances,  .         .         .         .         .         .-         .         .         .176 

Diagnosis 177 

Symptomatology,         .         .         .         .         .         .         .         .         .177 

The  Roentgen  ray,      .         .         .         .         .         .         .         ...      178 

Inconstancy  of  symptom  complex,       .         .         .         .         .         .     181 

Therapeutic  indications, .         .182 

Local  application, .182 

General  application,     .         .          .         .          .          .          .          .          .182 

Illustrative  Cases 183 

Treatment, 188 

Local  dry  hot  air  application,       .         .         .        ...         .         .188 

General  dry  hot  air  application,  .         .         .         .         ...     189 

Additional  remedial  measures,    .         .         .         .         .         .         .190 

Electricity, .190 

The  static  current,        .         .  .         .         .         .         .     190 

D'Arsonvalization,        ........     191 

The  continuous  current,       .......      191 

Magnetic-induced  current,    .         .  .         .         .         .     192 

Mechanical  vibratory  stimulation 192 


Contents.  xv 

PAGE 

Massage, 193 

Diet 193. 

Clothing. 193. 

Drugs,  .  194. 

Alteratives  and  tonics,  .         .         .         .         .         .194. 

The  salicylates,    .         .         .         .         .         .         .         .         .194. 

Laxatives,  .  .  .  .  .  .  .  .  .  •  '95 

Digestants 19^ 

Pain-relieving  agents,  195 

Management  of  affected  joints, 196 

Routine  treatment,        .         .         .         .         .         .         .         .         .196 

Relapses,  . 198 


CHAPTER  X. 

PERITONITIS;  PLEURITIS;  SYNOVITIS;  NEURITIS  AND  SCIATICA; 
LITH^EMIA  AND  GOUT;  NEURALGIA  AND  MYALGIA  ;  VARICOSE 
ULCERS  ;  OTITIS. 

Peritonitis, 200 

Varieties,        ...........     200 

Sphere  of  usefulness  of  dry  hot  air,       ......     200 

Illustrative  Case,         •    .         .         .         .         .         .         .         .         .     202 

Treatment,     ...........     206 

Local  dry  hot  air  application,     . 206 

General  dry  hot  air  application, 206 

Additional  remedial  measures, 206 

Pleuritis 211 

Varieties, .         .211 

Sphere  of  usefulness  of  dry  hot  air,       .         .         .  .         .211 

Treatment,     .         .         .         .         .         .         .         .         .         .         .212 

Local  dry  hot  air  application,     .  212 

General  dry  hot  air  application,         .         .         .         .         .         .212 

Additional  remedial  measures, 213, 

Synovitis,  .         .         .         .         .         .         .         .         .         .         .213 

Varieties .         .213 

Sphere  of  usefulness  of  dry  hot  aii ,        ......     213 

Treatment, 21 5. 

Local  dry  hot  air  application 215. 

After-care 215 

General  dry  hot  air  application, 216 

Additional  remedial  measures.  .         .         .         .         .         .216 

Neuritis, 217 


xvi  Contents. 

PAGE 

Etiology,       .        .        .        .        .        •                 •        •        •        •  2I7 
Treatment,    .         .        .        „"...-.         .         .         .         .217 

Dry  hot  air,        . 217 

Additional  remedial  measures, 218 

Electricity,   -  .         .         .         . 218 

Diet,        . .         .         .218 

Drugs,    ...        . 218 

Physiological  rest 219 

Sciatica,     ............  219 

Causation  and  pathology 219 

Sphere  of  usefulness  of  dry  hot  air 219 

Illustrative  Case,  .         .                  .         .         .         .         .         .         .  220 

Treatment,     .         .        .  .      . 221 

Sciatic  rheumatism, 221 

Sciatic  neuritis,           .        .         .         .         .         .         .         .         .  222 

Electricity,       .        .        .         .        .         .         .     '   .         .         .  222 

Mechanical  vibratory  stimulation,           .         .         .         ...  223 

Immobilization, 224 

Operative  interference, 224 

Lithaemia,         .        .        \        , 224 

Definition  of  term,         .         .        .    .     .         .         .         .         .         .  224 

Etiology,  pathology,  and  clinical  characteristics,          .         .         .  224 

Therapeutic  indications, 226 

Treatment,    ........                          .  226 

Diet,           .         .....         .         .         .         .         .  226 

General  dry  hot  air  application, 226 

Electricity  and  hydrotherapy, 227 

Drugs,      . 227 

Exercise,           . 227 

Gout,    .         .        . 227 

Neuralgia,        ..'.... 228 

Treatment,           . 229 

General  dry  hot  air  application, 229 

Local  dry  hot  air  application,     .......  229 

Electricity,         ..........  230 

Drugs, 230 

Myalgia 230 

Varicose  Ulcers, 231 

Treatment, 231 

Local  dry  hot  air  applications,      .         .  • 231 

General  dry  hot  air  applications, 231 

Electricity .         .231 


Contents.  xvii 

PAGE 

Drugs  and  surgical  dressings,       ...                  ...  232 

Otitis,         ...         .         .         . 232 

CHAPTER  XI. 

MISCELLANEOUS  CONDITIONS. 

Nervous  Debility  and  Exhaustion, 236 

General  debility  and  the  convalescent  state,          .         .        .         .  236 

Pulmonary  tuberculosis,    .         .         .         .         .        .         .         .        .  238 

Chronic  bronchitis,    .         .         .         .         .         .         .                  .         .  241 

Fibrous  anchylosis, 241 

Cholelithiasis,   .         .        . 242 

Gangrene, .         .         .         .         .  244 

Angina  pectoris,        .         %                 .         .         .'....         .  245 

La  grippe,          .         .         .         .      '  .         .         ...         .        .         .  246 

Syphilis,     .         .         .         .         .        .        .         .                  .  .      .         .  247 

Alcoholism,       .         .         .--...       .         .         .         .        .         .         .  247 

Gynecic  affections,    .         .         .         .                  .                 .                  ,  248 

Malaria,    .         .         .         ...      .         .         .         .         .         .        .  249 

Myositis,  .         .         .         ...         .        .        ,         ...         .  249 

Osteomyelitis,            .         .    '    ;         .         .        .         .         .         .         .  250 

Periosteitis,       .         .         .         .     •    ,        ..        .         .         ...  250 

Muscular  adhesions,           .        *.         .    •     .        .      '  .         .         .        .  250 

Skin  Diseases,  .         .         .         .         .        .         .        .         .        .251 

Plumbism, .        .        .         .         .  251 

Typhoid  fever,  .         .         .         .         .         ...         .      -.251 

Pains  of  flat-foot -     .         .                  .  253 

Obesity .         .         .         .  254 

CHAPTER   XII. 
FIELDS   OF   FUTURE    RESEARCH. 

Erysipelas '  255 

Tetanus,             . 255 

Lupus,      ............  256 

Surgical  Shock,         ..........  256 

Hodgkin's  Disease, 256 

Multiple  Neuritis 257 

Tabes  Dorsalis,        .                           .                  257 

Diabetes  Mellitus, 257 

Mental  Aberrations,        . 257 

The  Infectious  Diseases, 257 

Cerebro-Spinal  Meningitis,      ........  258 


LIST  OF  ILLUSTRATIONS. 

PAGE 

I.     The  Sprague  Body  Dry  Hot  Air  Apparatus    ...  3 
II.     Patient  Undergoing  Treatment  in  the  Sprague  Body  Ap- 
paratus        .........  3 

III.  Patient  Undergoing  Treatment  in  Betz  Body  Apparatus  5 

IV.  Pedal  End  of  a  Modified  Body  Apparatus        .         .         .  7 
V.     Cephalic  End  and  Side  of  a  Modified  Body  Apparatus    .  9 

VI.     Lentz  &  Sons'  Apparatus  for  the  Local  Application  of 

Dry  Hot  Air 12 

VII.     The  Sprague  Apparatus  for  the  Local   Application    of 

Dry  Hot  Air 13 

VIII.     Chair  Devised  by  the  Author  for  Use  in    Administering 

Local  Dry  Hot  Air  Treatments  to  the  Shoulder  Joint         17 
IX.     The  Hopkins  Generators   for    Applying   Dry  Hot   Air 

•via  the  External  Auditory  Canal         .         .         .19,  20,  21 
X.     Applying  Turkish-Toweling  Strips  Preparatory  to  Local 
Application  of  Dry  Hot  Air  to  Knee  with  Special  Knee 
Apparatus    .........       45 

XI.     Patient  Prepared  for  Local  Application  of  Dry  Hot  Air 

to  Knee  with  Special  Knee  Apparatus          ...       47 
XII.     Patient  Prepared  for  Local  Application  of  Dry  Hot  Air 

to  Leg  from  Knee  Downward       .         .         .         .         .49 

XIII.  Local  Application  of  Dry  Hot  Air  to  Leg   from    Knee 

Downward  with  Betz  General  Local  Apparatus  .       51 

XIV.  Local  Application  of  Dry  Hot  Air  to  Knee  with  Betz 

Special  Knee  Apparatus       ......  53 

XV.     Position   of   Covering   Preparatory   to    Adjustment   for 

Local  Dry  Hot  Air  Application  to  Shoulder         .         .  59 

XVI.     Shoulder  Prepared  for  Local  Dry  Hot  Air  Application  61 

XVII.     Local  Dry  Hot  Air  Application  to  Shoulder    ...  63 

XVIII.     Hip  Prepared  for  Local  Dry  Hot  Air  Application  .  65 

XIX.     Local  Dry  Hot  Air  Application  to  Hip    .         .         .         .  67 

XX.     Local  Dry  Hot  Air  Application  to  Lumbar  and  Sacral 

Regions 69 

XXI.     Patient  Prepared  for  Local  Dry  Hot  Air  Application  to 

Left  Lung  or  Pleura?      .  ....  71 


xx  Illustrations. 

PAGE 

XXII.     Patient  Prepared  for  Body  Dry  Hot  Air  Treatment  with 

the  Betz  Body  Apparatus .77 

XXIII.  Local  Application   of  Dry  Hot    Air  to  Left  Lung  or 

Pleurae 145 

XXIV.  Changes  in  Joint  Structures  Produced  by  Arthritis  De- 

formans  of  the  Fingers 179 

XXV.  Normal  Finger  Joints  (a  Fragment  of  a  Needle  Appears 

Imbedded  in  the  Middle  Finger  opposite  the  Third 
Phalanx) .         .         .179 

XXVI.  Arthritis  Deformans  of  the  Knee  .         .         .         .181 
XXVII.     Patient  Prepared  for  Local  Application  of  Dry  Hot  Air 

to  Abdomen       ....         ....     207 

XXVIII.     Local  Application  of  Dry  Hot  Air  to  Abdomen     .         .     209 


THERAPEUTICS  OF  DRY  HOT  AIR. 

CHAPTER  I. 

APPARATUS. 

Outfit. 

Three  forms  of  apparatus  are  essential  in  order  that  the 
most  may  be  gotten  out  of  dry  hot  air  therapeusis  as 
applied  to  the  practice  of  general  medicine:  a  large  one  for 
treating  the  whole  body  at  once;  a  smaller  one  for  treating 
hands,  wrists,  elbows,  shoulders,  backs,  abdomens,  hips,  ankles, 
and  feet ;  and  a  short  one,  open  at  both  ends,  for  treating  anky- 
losed,  flexed  knees. 

Construction. 

All  of  these  consist  in  general  of  metal  cylinders  lined  with 
some  non-conducting  material,  and  are  susceptible  of  being 
closed  at  both  ends  in  such  a  way  as  to  confine  the  air  they 
contain  about  the  part  to  be  treated.  The  proximal  end  is 
closed  by  cloth  attachments  so  constructed  as  to  fit  the  different 
regions  of  the  body  to  which  it  may  be  desired  to  apply  the 
heat;  the  distal  end  by  curtains  of  cloth  or  a  permanent  metal 
stopper. 

Gas,  gasoline,  electricity,  and  alcohol  are  used  for  generat- 
ing the  heat,  and  high  temperature  thermometers  are  placed 
conveniently  for  registering  the  intensity  obtained. 

There  are  several  makes  of  apparatus  on  the  market,  the 
working  principle  of  all  being  the  same,  but  they  differ  in  con- 
struction and  price.  That  manufactured  by  F.  S.  Betz  &  Co., 
of  Chicago,  111.,  and  the  Sprague  apparatus  made  by  the  Kny- 
Scheerer  Co.,  of  New  York,  N.  Y.,  are  most  commonly  used 
in  this  country.  As  it  is  the  cardinal  principles  of  construction 
rather  than  the  details  that  combine  to  render  an  apparatus 


2  Therapeutics  of  Dry  Hot  Air. 

of  this  character  therapeutically  efficient,  and  as  the  details  can 
be  secured  from  the  different  manufacturers  without  difficulty, 
only  the  essential  attributes  that  must  be  common  to  all  dry 
hot-  air  machines  in  order  that  they  shall  be  therapeutically  re- 
liable will  be  mentioned  here ;  these  are  as  follow : 

THE    BODY    APPARATUS. 

This  should  be  capable  of  generating  a  heat  of  at  least  300° 
F.  in  fifteen  minutes  and  350°  F.  in  thirty  minutes  at  the  out- 
side, and  of  sustaining  it  there  for  at  least  an  hour. 

The  source  of  heat  should  be  so  arranged  that  the  flame 
cannot  be  directed  toward  the  patient  without  having  some 
non-conducting  material  interposed,  however  great  the  distance 
between  them. 

It  should  be  provided  with  some  arrangement,  by  valves  or 
otherwise,  whereby  the  air  may  be  changed  frequently  with- 
out lessening  the  heat  to  any  great  extent.  If  free  circulation 
of  air  in  the  apparatus  is  not  attainable  it  will  become  so  sat- 
urated with  moisture  that  the  skin  of  the  patient  will  be  in 
danger  of  blistering. 

Because  of  its  size  and  weight  this  form  of  apparatus  is 
not  portable,  hence  is  available  only  when  the  patient  can  be 
brought  to  it  and  in  sanitariums  or  hospitals. 

When  illuminating  gas  is  used  for  heating  this  form  of  ap- 
paratus a  pipe  at  least  three-quarters  of  an  inch  in  diameter, 
and  connected  directly  with  the  large  street  service  pipe,  should 
be  directly  available  for  supplying  the  burners  under  the  ordi- 
nary pressure  conditions.  With  a  smaller  supply  than  this  it 
will  not  usually  be  possible  to  secure  the  high  temperatures 
without  which  satisfactory  results  cannot  be  attained  in  many 
conditions. 

Structural  Modification  of  Body  Apparatus. — There  are 
two  forms  of  body  apparatus;  one  in  which  both  ends  of  the 
cylinder  are  closed  by  cloth  curtains,  and  the  other  in  which 
only  the  cephalic  end  is  so  constructed,  the  pedal  end  being 
permanently  occluded  by  a  metal  stopper.  As  will  be  seen 
in  a  later  chapter,  the  sensitiveness  of  the  toes  of  some  patients 
renders  it  necessary  to  conduct  the  application  by  this  appa- 


Apparatus. 


I.— The  Sprague  Body  Dry  Hot  Air  Apparatus. 


II. — Patient  Undergoing  Treatment  in  Sprague  Body  Dry  Hot  Air 
Apparatus. 


Apparatus.  n 

ratus  with  these  members  entirely  outside  of  the  heat  reservoir; 
hence  with  the  last-mentioned  form  of  body  apparatus  it  is 
desirable  to  effect  some  changes  in  its  construction  whereby 
this  object  may  be  attained,  and  the  aid  of  a  tinsmith  must  be 
invoked. 

The  whole  upper  segment  of  the  pedal  end  of  the  cylinder 
down  to  a  point  an  inch  or  two  below  the  under  side  of  the 
rolling  couch  should  be  cut  out,  so  that  the  end  of  the  car 
upon  which  are  the  patient's  feet  can  be  rolled  far  enough 
through  the  pedal  end  of  the  cylinder  to  allow  those  members 
to  project  beyond  the  limits  of  the  heat  chamber.  Curtains 
of  heavy  awning  cloth  should  then  be  fitted  to  the  upper  and 
under  borders  of  the  opening  thus  made,  in  the  same  manner 
as  they  are  arranged  at  the  cephalic  end  of  the  cylinder,  and 
of  such  shape  and  size  as  will  allow  the  upper  curtain  to  be 
tucked  around  the  patient's  ankles  and  the  under  curtain  to 
be  drawn  snugly  against  the  under  side  of  the  rolling  couch. 
This  arrangement  answers  the  purpose  admirably  and  is  en- 
tirely effectual  in  preventing  undue  escape  of  the  heated  air. 

As  the  hot  air  reservoir  in  the  machine  with  permanently- 
closed  end  is  five  feet  long,  it  follows  that  with  patients  of 
medium  height  the  head  would  be  inside  the  reservoir  when 
the  feet  were  protruded  as  above,  so  that  it  becomes  necessary 
also  to  cut  off  about  sixteen  inches  of  the  cylinder ;  this  is  most 
advantageously  accomplished  by  taking  some  from  each  end. 
Cut  IV  shows  the  pedal  end  of  such  an  apparatus  which  has 
been  altered  in  accordance  with  the  above  suggestions,  and 
Cut  V  shows  the  side  and  cephalic  end.  Six  inches  were  cut 
off  from  the  pedal  end  and  ten  inches  from  the  upper  half  of 
the  cephalic  end,  as  shown  in  the  cut. 

Another  modification  shown  in  Cut  V  is  the  hole  in  the 
side  near  the  top ;  it  is  seven  inches  square,  fitted  with  a  sliding 
door,  and  is  used  for  ventilating  the  apparatus.  The  rapidity 
with  which  the  air  is  changed  may  be  regulated  at  will  by 
sliding  the  door  backward  or  forward  so  as  to  increase  or 
diminish  the  size  of  the  aperture. 


12  Therapeutics  of  Dry  Hot  Air. 

THE   GENERAL   LOCAL   APPARATUS. 

This  is  the  one  most  useful  to  the  general  practitioner.  A 
very  important  requirement  is  that  it  be  portable  as  it  is  fre- 
quently desirable  to  employ  it  at  the  bedside  in  some  acute 
diseases. 

It  should  be  capable  of  generating  a  heat  of  at  least  400°  F. 


VI. — Lentz  &  Sons'  Apparatus  for  the  Local  Application  of  Dry  Hot  Air. 

in  at  most  thirty  minutes  and  of  sustaining  it  there  for  at  least 
an  hour. 

The  same  conditions  as  to  arrangement  of  the  source  of 
heat  with  relation  to  the  patient  apply  here  as  with  the  body 
apparatus,  but  with  more  force,  because  the  temperatures  used 
are  higher. 

An  arrangement  for  securing  free  circulation  of  the  air  is 
also  essential  in  this  apparatus.  A  very  serviceable  modifica- 
tion consists  in  having  the  ventilation  valve  in  the  top  enlarged 
to  a  hole  five  inches  square  and  fitted  with  a  sliding  door;  an 


Apparatus.  \  3 

arrangement  similar  to  that  shown  in  Cut  V    on  the  body 
apparatus.  ,  ; 


VII. — The  Sprague  Apparatus  for  the  Local  Application  of  Dry  Hot  Air. 

THE    KNEE    APPARATUS 

Theoretically  the  same  requirements  noted  in  connection  with 
the  two  preceding  forms  of  apparatus  should  apply  with  equal 
force  to  this  one ;  there  are  practical  difficulties  in  the  way  of 
securing  the  higher  degrees  of  heat,  however,  which  will  be 
noted  and  discussed  in  the  chapter  on  technique. 

Internal   Distribution   of  Heat. 

An  essential  of  prime  importance  as  regards  efficiency  in  all 
these  forms  of  apparatus  is  that  the  heat  should  equalize  itself 


14  Therapeutics  of  Dry  Hot  Air. 

within  narrow  limits  in  all  localities  inside  of  the  reservoir 
after  the  apparatus  is  thoroughly  heated.  Schreiber  conducted 
a  series  of  thermometric  observations  with  some  dry  hot  air 
machines  of  foreign  make  and  ascertained  that  a  difference 
sometimes  obtained  between  the  temperature  of  the  air  which 
actually  came  in  contact  with  the  patient,  and  that  in  the  local- 
ity ordinarily  occupied  by  the  thermometer,  of  fifty  per  cent, 
of  the  thermometer  reading.  A  construction  producing  such 
conditions  renders  the  apparatus  entirely  unfit  for  therapeutical 
purposes.  The  discrepancy  should  not  exceed  five  per  cent,  of 
the  thermometer  reading  with  a  body  apparatus,  or  fifteen  per 
cent,  with  one  designed  for  local  application,  and  thermomet- 
ric determinations  made  by  the  writer  demonstrate  that  these 
limits  need  never  be  exceeded.  In  apparatus  of  American 
manufacture  they  are  not  usually  reached.  The  simpler  the 
design  of  the  machine  the  more  effectually  will  the  convection 
currents  effect  a  thermal  equilibrium. 

Elimination  of  Moisture. 

It  has  been  suggested  that  dryness  of  the  air  in  the  cylinders 
might  be  maintained  by  the  use  of  some  absorbent  substance 
inside  the  apparatus,  or  by  passing  a  static  electrical  discharge 
through  a  tube  located  in  the  interior  of  the  reservoir  whereby 
the  moisture  would  be  precipitated  upon  the  tube;  by  such 
means  temporary  slight  irregularities  of  temperature  caused  by 
changing  the  air  in  the  apparatus  might  be  avoided.  To  dis- 
pose of  the  point  it  is  only  necessary  to  consider  that  at  the 
high  temperatures  necessary  for  therapeutical  purposes  no 
chemical  is  known  that  would  retain  the  moisture  even  if  it 
were  possible  for  it  to  absorb  it  under  such  conditions,  and 
however  successful  we  might  be  in  precipitating  the  moisture 
by  electrical  or  any  other  means,  it  would  inevitably  vaporize 
again  immediately  upon  coming  in  contact  with  a  solid  body 
so  heated.  Changing  the  air,  therefore,  is  the  only  practical 
means  now  available  for  maintaining  dryness,  and  the  efficiency 
and  convenience  of  the  procedure  are  such  that  no  other  need 
be  sought  for;  its  actual  influence  in  disturbing  the  treatment 
temperature  after  the  apparatus  has  once  become  thoroughly 
heated,  is  found  in  practice  to  be  entirely  negligible. 


Apparatus.  1 5 

Fire-Proof  Cloth  Fittings. 

Although  reasonably  close  observance  of  the  cautions  which 
will  be  detailed  in  the  chapter  on  technique  will  eliminate  any 
danger  of  serious  ignition  of  the  cloth  attachments  of  the 
machines,  yet  scorching  will  occur  which  greatly  shortens  their 
periods  of  usefulness.  This  disadvantage  may  be  obviated  or 
lessened  by  substituting  asbestos  cloth  for  the  fabric  ordinarily 
used  in  their  construction,  or  by  treating  the  attachments  be- 
fore they  are  used  with  some  fire-proofing  solution,  the  follow- 
ing being  a  fairly  efficient  example ;  it  is  known  as  the  "  Home 
Office  Method,"  and  is  used  by  the  explosives  department  of 
the  British  Home  Office  for  fire-proofing  inflammable  sub- 
stances : 

Sodium  tungstate  (normal  salt)  4  ounces  or  q.  s.  to  make 
Sol.  Sat. 

Water,  30  ounces. 

Dissolve  in  the  cold  and  add 

Sodium  phosphate,  2  ounces, 

Water,  6  ounces, 

or  a  sufficiency  of  water  to  make  the  specific  gravity  of  the 
solution  1140. 

The  fabrics  are  soaked  in  this  solution  about  half  an  hour 
until  thoroughly  saturated  therewith,  placed  in  the  apparatus 
without  being  squeezed  so  as  to  retain  in  the  meshes  of  the 
cloth  all  of  the  solution  that  can  be  held  therein,  and  heated 
at  350°  F.  to  remove  the  organic  acid  and  cause  the  tungstate 
precipitate  to  be  formed  in  the  fiber,  until  dry. 

The  use  of  asbestos  cloth  is  the  most  satisfactory,  as  it  elimi- 
nates absolutely  any  possibility  of  ignition;  the  fire-proofing 
solution  lengthens  considerably  the  life  of  the  fittings,  how- 
ever, and  is  less  expensive. 

When  asbestos  cloth  is  used  for  the  curtains  of  the  body 
apparatus  or  the  various  attachments  of  the  local  machine,  the 
wear  upon  it  will  be  greatly  lessened  by  having  a  layer  of  ordi- 
nary awning  cloth  outside  of  the  asbestos,  thus  making  a  cur- 
tain of  double  thickness,  the  inner  layer  being  of  asbestos  and 
the  outer  of  awning  cloth. 

In  some  body  machines  inflammable  material,  as  wood,  is 


1 6  Therapeutics  of  Dry  Hot  Air. 

used  in  the  construction  of  the  couch  upon  which  the  patient 
lies.  After  a  while  this  will  burn  out,  when  it  may  advan- 
tageously be  replaced  with  heavy  wire  netting  fastened  to  the 
couch  at  the  ends  and  supported  midway,  where  necessary,  by 
thin  iron  bands  running  transversely  with  their  ends  fastened  to 
the  sides  of  the  couch.  This  arrangement  presents  the  advan- 
tage of  forming  a  flexible  surface  which  gives  considerably  to 
the  prominent  portions  of  the  body,  whereby  the  patient  is  ren- 
dered much  more  comfortable. 

Source  of  Heat. 

As  already  stated,  gas,  gasoline,  electricity,  and  alcohol  are 
used  to  excite  dry  hot  air  generators,  and  which  agent  is 
selected  will  depend  upon  the  facilities  of  the  individual  oper- 
ator. If  electricity  is  used  the  heating  power  of  the  current 
should  be  utilized  through  a  non-luminous  resistance  and  not 
through  the  medium  of  incandescent  lamps. 

Gas  is  the  most  frequently  available,  is  very  convenient,  en- 
tirely efficient,  and  exhibits  but  one  disadvantage.  In  some 
cities  the.  pressure  under  which  it  is  delivered,  and  in  some 
houses  the  total  supply  capacity,  are  not  great  enough  to  fur- 
nish adequate  heating  power  for  the  high  temperatures  fre- 
quently necessary  of  attainment,  and  if  one  applies  many 
treatments  outside  of  his  own  specially-equipped  operating 
room,  this  point  assumes  an  aspect  of  considerable  importance. 
The  difficulty  may  be  overcome  by  always  using  gasoline 
(special  gasoline  burners  and  other  fittings  necessary  when 
this  agent  is  used  will  be  furnished  upon  specification,  by  the 
manufacturer)  when  giving  a  treatment  at  the  home  of  a 
patient,  instead  of  depending  upon  the  gas  supply  in  the  house. 
Strict  adherence  to  this  rule  will  save  one  many  exasperating 
bedside  disappointments. 

If  the  apparatus  and  treatment  room  are  susceptible  of  proper 
ventilation,  the  possible  deleterious  influence  upon  the  patient 
of  aerial  contamination  by  products  of  combustion  devel- 
oped by  the  bare  flames  of  gas-burners,  sometimes  urged 
against  the  use  of  gas  for  this  purpose,  will  be  entirely  neg- 
ligible. 


Apparatus. 


Special  Chair  for  Local  Ap- 
plication to  Shoulder. 

Although  dry  hot  air  may 
be  applied  to  this  region  with 
the  patient  reclining  upon  an 
ordinary  chair  or  couch,  yet 
it  will  be  found  conducive  to 
the  comfort  of  both  patient 
and  operator  and  to  the  effi- 
ciency of  the  treatment  if  a 
chair  especially  adapted  for 
this  purpose  is  at  hand.  Cut 
VIII  shows  the  front  view  of 
such  a  chair  and  also  its  lat- 
eral aspect.  It  is  made  upon 


VIII. — Chair  Devised  by  the  Author  for  Use  in 
Administering  Local  Dry  Hot  Air  Treatments 
to  the  Shoulder  Joint. 


the  principle  of 
a  steamer  chair, 
the  frame  being 
of  wood  and  the 
support  for  the 
occupant  of  can- 
vas. When  an 
ordinary  chair 
or  couch  is  used 
the  cloth  attach- 
ment connecting 
the  apparatus  to 
the  shoulder 
will  be  crushed 
against  the  body 
when  the  patient 


1 8  Therapeutics  of  Dry  Hot  Air. 

leans  back'  and  the  heated  air  will  thus  be  prevented  from 
reaching  the  posterior  portion  of  the  joint ;  if  the  patient  leans 
far  enough'  laterally  to  overcome  this  condition  his  position  will 
shortly  become  irksome.  The  sharp  backward  curving  of  the 
side-pieces  and  .the  shaping  of  the  canvas  back  at  the  level  of 
the  shoulders  shown  in  Cut  VIII  obviate  this  difficulty  entirely 
and  render  it  possible  to  carry  the  heat  as  far  toward  the 
median  line  as  the  inner  border  of  the  scapula. 

Location  of  Apparatus. 

Little  need  be  said  as  to  the  setting  of  the  local  dry  hot  air 
generators  except  that  the  comfort  of  both  patient  and  operator 
will  be  enhanced  if  the  room  wherein  the  treatment  is  to  be 
given  is  provided  with  a  window  which  can  be  opened  during 
the  application.  The  great  majority  of  these  treatments  can 
be  given  at  an  ordinary  bedside  as  conveniently  as  in  a  room 
especially  prepared  for  the  purpose. 

The  greater  size,  hence  greater  heating  and  de-oxygenat- 
ing capacity  as  regards  the  air  of  the  room,  of  the  body  appa- 
ratus, however,  renders  free  ventilation  by  open  windows  or 
otherwise  an  essential  feature  of  the  apartment  wherein  these 
applications  are  to  be  administered,  and  in  the  summer  time 
at  least  an  electric  fan,  so  arranged  that  the  breeze  can  be 
directed  upon  the  patient,  will  be  found  to  constitute  a  most 
desirable  feature  of  its  equipment. 

It  is  also  desirable  to  have  the  bathing  facilities  as  near  the 
treatment  room  as  possible  so  that  the  patient  will  not  have 
far  to  go  after  cooling.  A  couch  upon  which  the  patient  can 
be  given  an  alcohol  rub  and  left  to  rest  for  an  hour  or  two 
after  the  treatment,  should  be  located  in  a  room  conveniently 
accessible  from  the  bathroom. 

Other  minor  details  will  suggest  themselves  as  the  individual 
operator  develops  his  facilities. 

DEVICES    FOR    APPLYING    DRY    HOT    AIR    TO   THE 

OPEN   CAVITIES    OF    THE    BODY. 

Modifications  of  the  previously  described  forms  of  apparatus, 
more  or  less  well  adapted  for  applying  this  agent  to  open  cavi- 
ties, are  procurable,  but  as  they  have  been  employed  to  only 
a  limited  extent  as  yet,  their  actual  therapeutical  value  cannot 
be  passed  upon  with  any  degree  of  conclusiveness. 


Apparatus. 


External  Auditory  Canal. 

One  of  them,  however,  the  Hopkins  heater,  designed  by 
Hopkins,  of  Cleveland,  O.,  for  use  in  the  external  ear  and 
made  by  the  Terry  Heater  Co.,  of  Cincinnati,  O.,  deserves 
more  than  a  mention,  because  of  the  very  satisfactory  results 
that  have  been  reported  from  its  use.  It  is  made  in  three 
forms  so  that  alcohol,  illuminating  gas,  or  electricity  may  be 
utilized  as  the  source  of  heat.  The  air  is  compressed  before 
being  heated,  so  that  it  is  delivered  to  the  field  of  operation 
with  some  force. 

The  Alcohol  Heater  (Cut  IX). — This  form  consists  of  a 
metal  cone  segment,  around  the  inside  of  which  is  wound  a 


IX  ./.— Alcohol  Heater. 


IX  A. — Cross-Section. 


tapering  coil  of  copper  tubing.     Beneath  it  is  an  alcohol  lamp 
which  heats  the  coil  to  a  high  temperature  in  a  few  minutes. 


20 


Therapeutics  of  Dry  Hot  A  ir. 


Compressed  air  from  a  tank,  pump,  or  bulb  enters  the  heating 
coil  at  the  bottom  through  rubber  tubing,  and  leaves  it  at  the 
top  through  a  metallic  delivery  tube  having  two  rotary  joints 
which  make  it  adaptable  to  any  position  of  the  patient,  the 
delivery  tube  terminating  in  a  vulcanized  fiber  ear-tip  shaped 
somewhat  like  an  ear  speculum.  This  ear- tip  is  said  not  to 
become  inconveniently  hot  even  when  the  hottest  air  is  passing 
through  it.  The  capacity  of  this  heater  as  regards  temperature 
elevation  of  the  air  delivered  is  said  to  be  much  less  than  that 
exhibited  by  those  utilizing  gas  or  electricity. 

The  Gas  Heater   (Cut  IX). — This  form  consists  of  a  blue- 

x  ' 

flame  burner,  over  which  is  similarly  arranged  a  larger  coil  o*f 


IX  B.— Gas  Heater. 


IX  B.— Cross-Section. 


copper  tubing,  and  the  compressed  air  enters  and  leaves  the 
coil  in  the  same  manner. 


Apparatus. 


21 


The  Electric  Heater  (Cut  IX).— This  machine  is  operated 
by  the  I  lo-volt  lighting  circuit  through  an  ordinary  socket  and 
plug  and  can  be  used  on  either  the  direct  or  alternating  current. 


IX  C.—  Electric  Heater. 


IX  C— Cross-Section. 


It  consists  of  an  air-tight  tube  holding  within  it  a  coil  of  wire 
which  is  heated  by  the  current.  This  tube  is  surrounded  by  a 
nickel-plated  envelope,  the  intervening  space  being  packed  with 
asbestos.  The  wires  enter  the  tube  at  the  bottom  through  a 
bushing.  The  compressed  air  enters  the  tube  at  the  bottom 
and  leaves  it  at  the  top  as  with  the  alcohol  and  gas  heaters. 
Air  passing  through  this  appliance  acquires  its  maximum  tem- 
perature elevation  (over  400°  F.)  in  eight  minutes. 

A  marked  advantage  exhibited  by  the  Hopkins  machines 
is  that  the  compressed,  heated  air  is  compelled  to  escape,  with 


22  Therapeutics  of  Dry  Hot  Air. 

a  degree  of  force  which  is  absolutely  controllable,  at  exactly 
the  spot  desired  and  nowhere  else. 

Directions  for  setting  up  and  operating  all  of  these  outfits, 
together  with  complete  fittings  and  descriptions  thereof,  arc 
furnished  by  the  manufacturers. 


CHAPTER    II. 
PHYSIOLOGICAL   ACTION. 

COMPREHENSION  of  the  applicability  of  this  agent  to 
different  disease  processes,  of  the  rationale  of  its  action,  and 
of  the  value  of  the  services  it  renders  will  be  facilitated  if  the 
following  is  borne  prominently  in  mind  while  considering  this 
subject,  viz.,  that  in  at  least  a  large  majority  of  pathological 
conditions  Nature's  attempt  to  rid  herself  of  disability  is  sim- 
ply and  solely  through  an  accentuation  or  exaggeration,  direct 
or  indirect,  of  the  normal  metabolic  processes.  As  illustra- 
tions may  be  mentioned  the  increase  in  local  trophic  activity 
accompanying  repair  in  wounds ;  the  increase  in  cell  production 
whereby  it  is  attempted  to  wall  off  a  chronic  inflammatory  focus 
from  the  rest  of  the  organism ;  the  acceleration  of  metabolism 
whereof  the  phenomenon  of  fever  is  the  outward  and  visible 
sign,  is  also  believed  by  many  to  be  simply  an  expression  of 
Nature's  effort  to  rid  herself  of  deleterious  agencies  by  augmen- 
tation of  the  normal  vital  processes,  through  which  alone  is 
she  able  to  resist  or  destroy  such  agencies. 

The  greater  the  facility  and  vigor  with  which  normal  tissue 
changes  are  carried  on  the  greater  will  be  the  individMal's 
vitality,  hence  capacity  for  resisting  influences  antagonistic  to 
his  well-being  and  of  overcoming  the  results  of  such  in- 
fluences if  he  should  become  a  victim  thereto. 

Differentiation  from  Other  Methods  of 

Administering  Heat. 

Electric  Arc  and  Incandescent  Light  Baths. — A  most 
important  point  to  be  borne  in  mind  in  this  connection  is  thai 
dry  hot  air  is  not  radiant  heat  or  moist  heat.  The  physiological 
influences  of  the  electric  arc  and  incandescent  light  baths  are 
radically  different  in  several  respects  from  those  of  the  dry 
hot  air  application  proper,  the  former  being  a  combination,  in 

23 


24  Therapeutics  of  Dry  Hot  Air. 

varying  proportions  and  degrees  of  intensity,  of  both  heat  and 
light  effects,  the  radiant  element  being  always  predominant, 
•however.  With  the  dry  hot  air  application,  properly  so  called, 
we  do  not  get  any  of  the  characteristic  effects  of  light  waves 
upon  cell  life,  and  clinically,  the  work  of  Cleaves,  Crothers, 
and  others  would  seem  to  indicate  that  the  radiant  heat  bath 
differs  radically  in  at  least  one  particular  from  its  non-luminous 
congener,  viz.,  in  its  greater  power  of  producing  sedation  of 
the  irritable  nervous  system. 

The  purely  thermal  element  in  the  radiant  heat  application 
is  necessarily  much  less  intense  than  in  the  dry  hot  air  appli- 
cation proper  because  of  the  predominance  of  the  chemical 
rays  in  the  former.  We  should  expect,  then,  that  radiant  heat 
would  not  be  able  to  perform  the  work  of  dry  hot  air,  and  that 
the  latter  would  fail  in  some  respects  to  accomplish  the  results 
attainable  with  its  radiant  relative,  and  experience  proves  this 
to  be  true.  The  explanation  of  the  difference  in  the  physio- 
logical influences  characteristic  of  dry  hot  air  as  compared  with 
radiant  heat,  is  found  principally  in  the  greater  power  exhib- 
ited by  dry  hot  air  to  induce  elimination  and  to  influence  by 
reflex  stimulation  the  deep  nerve  centers. 

Hydrotherapy. — Its  physiological  effects  must  also  be  dif- 
ferentiated from  those  of  the  various  hydrotherapeutic  proced- 
ures in  which  a  greater  or  less  degree  of  heat  is  employed.  In 
the  latter  the  degrees  of  heat  administered  are  necessarily  much 
less  than  with  dry  hot  air  applications  proper  because  they  are 
applied  by  means  of  water,  and  the  physiological  effects  of 
mild  degrees  of  heat  are  in  some  respects  directly  the  reverse 
of  those  obtainable  by  the  use  of  high  intensities.  In  addition 
to  this  we  have  to  reckon,  in  some  of  the  hydriatic  modalities, 
with  the  element  of  percussion,  which  still  further  modifies  any 
possible  resemblance  that  might  otherwise  obtain. 

The  differences  in  the  elements  which  combine  to  produce 
the  characteristic  influences  obtainable  by  the  use  of  these  three 
methods  of  applying  heat,  then,  are  sufficiently  marked  to  con- 
stitute radical  differences  in  the  spheres  of  action  of  dry  heat, 
radiant  heat,  and  hydrotherapy,  and  in  the  securing  of  a  satis- 
factory therapeutical  result  the  selection  becomes  a  matter  of 


Physiological  Action.  25 

importance;    they    are    by   no    means    mutually   interchange- 
able. 

Varieties  of  Application  and  Nomenclature. — There  are 
two  varieties  of  dry  hot  air  applications ;  one  where  the  greater 
part  of  the  body  surface,  sometimes  the  whole  of  it  up  to  the 
neck,  is  subjected  to  influence  and  which  is  denominated  the 
"  General  Application  "  or  "  Body  Treatment,"  and  the  other 
where  only  the  part  involved  in  a  pathological  process  is  in- 
cluded in  the  field  of  operation  and  which  is  denominated  the 
"  Local  Application  "  or  "  Local  Treatment."  The  physio- 
logical actions  of  these  two  varieties  of  administration  differ 
from  each  other  in  degree  and  to  a  certain  extent  also  in  kind ; 
we  will,  therefore,  consider  them  separately,  beginning  with 
the  major  procedure. 

GENERAL   APPLICATION. 

Clinical  and  laboratory  observations  made  in  connection  with 
patients  under  treatment  by  the  writer  have  demonstrated  that 
the  following  objective  phenomena  are  susceptible  of  imme- 
diate induction  by  the  body  treatment,  and  that  they  persist 
with  decreasing  intensity  for  from  four  to  forty-eight  hours, 
rarely  longer,  the  lime  varying  in  different  diseases  and  with 
different  patients. 

Body  Temperature. — The  mouth  temperature  rises  from 
one  to  five  degrees  Fahrenheit,  according  to  the  length  and 
intensity  of  the  application  and  the  susceptibility  to  stimula- 
tion of  the  individual  patient's  nerve  centers. 

Pulse. — The  rate  is  accelerated  from  thirty  to  fifty  beats 
per  minute,  and  the  impulse  is  markedly  increased  in  volume. 
If  it  was  weak  before  treatment  it  becomes  strong  during 
administration.  If  the  application  is  continued  too  long  it  loses 
its  volume  and  strength,  becoming  rapid,  small,  and  soft; 
under  these  conditions  the  patient  becomes  faint,  dizzy,  and 
nauseated. 

Respiration. — The  breathing  deepens  some  and  the  rate 
increases  from  five  to  ten  cycles  per  minute;  this  modification 
of  function  is  not  accompanied  by  any  sensation  of  oppression 
on  the  part  of  the  patient,  however ;  rather  the  reverse,  in  fact. 


26  Therapeutics  of  Dry  Hot  Air. 

Skin. — The  capillary  areas  become  injected,  but  this  phe- 
nomenon is  not  as  marked  in  the  regions  actually  in  contact 
with  the  heat  as  in  the  local  treatment.  The  fact  that  the 
capillaries  of  the  face,  which  is  never  subjected  to  the  heat, 
share  this  general  distention  even  when  constantly  under  the 
influence  of  the  breeze  from  an  electric  fan,  demonstrates  the 
profundity  of  the  influence  obtained  and  that  it  is  essentially 
reflex  in  character. 

The  sweat-glands  functionate  copiously,  sometimes  excreting 
several  pounds  (from  one  to  five)  during  treatment;  if  dropsy 
is  present  the  excretion  may  be  much  greater  even. 

Blood. — The  number  of  white  corpuscles  is  increased  in 
different  cases  from  fifteen  to  fifty  per  cent. 

The  red  blood  cells  are  increased  from  ten  to  twenty  per 
cent. 

Urine. — The  quantity  passed  in  the  twenty-four  hours 
succeeding  the  treatment  is  usually  increased  from  twenty-five 
to  one  hundred  per  cent,  over  that  passed  during  the  twenty- 
four  hours  preceding.  In  occasional  instances,  however,  a  de- 
crease in  the  quantity  is  observed. 

The  quantity  of  urea  excreted  in  the  twenty-four  hours  suc- 
ceeding the  treatment  is  increased  from  fifteen  to  sixty  per 
cent,  over  that  excreted  during  the  twenty-four  hours  previous. 

Variations  in  Extent  of  Influence  Induced. — The  degrees 
in  which  these  several  phenomena  are  found  to  be  present  differ 
widely  in  different  cases,  and  at  present  it  is  not  possible  to 
define  positively  the  reasons  for  the  variation  or  the  conditions 
under  which  it  may  be  expected  to  appear.  A  general  rule 
which  seems  to  apply  fairly  constantly,  however,  is  that  the 
greater  the  departure  from  normal  function  in  a  direction  the 
reverse  of  that  in  which  tends  the  influence  of  the  dry  hot  air 
treatment,  the  more  pronounced  will  be  the  effect  of  the  treat- 
ment in  the  direction  indicated  above.  For  instance,  in  patho- 
logical conditions  characterized  by  a  deficient  excretion  of  urine 
or  urea,  the  increase  in  the  excretion  of  these  compounds  may 
be  expected  to  be  pronounced;  in  cases  exhibiting  a  marked 
hyperleucocytosis  on  the  other  hand,  only  a  slight  increase  in 
the  number  of  leucocytes,  sometimes  none  at  all,  and  again 


Physiological  Action.  27 

an  actual  decrease  may  be  observed,  especially  if  the  patho- 
logical process  which  is  responsible  for  the  excessive  formation 
of  white  corpuscles  is  gotten  under  immediate  control.  In 
healthy  individuals  who  exhibit  no  departure  from  the  normal, 
only  slight  modification  may  be  expected  in  most  cases ;  nearly 
always  some  is  observable,  however,  in  the  directions  noted 
above. 

Subjective  Phenomena. — The  sensation  is  rarely  disagree- 
able to  the  patient,  but  quite  the  reverse  usually.  A  pleasant 
languor  is  produced  after  about  ten  minutes  which  lasts  for  an 
hour  or  two;  after  the  treatment  the  patient  usually  becomes 
drowsy  and  sleeps.  If  the  application  is  continued  too  long 
the  languor  gives  place  to  exhaustion,  sometimes  accompanied 
by  cardiac  palpitation  and  oppressed  breathing  which  may  per- 
sist for  hours.  A  sense  of  exhilaration  and  increased  vitality 
follows  the  treatment  when  well  administered. 

Rationale  of  Action. — Through  the  elevation  of  the  tem- 
perature of  the  body  en  masse  and  the  profound  reflex  stimu- 
lation of  the  deep  nerve  centers,  are  secured,  first,  a  more  rapid 
and  complete  oxidation  of  effete  materials  which  are  clogging 
metabolic  processes,  figuratively  speaking,  into  normal  ex- 
cretory products — urea  for  the  kidneys,  CO2  for  the  lungs, 
etc. — which  are  then  easily  disposed  of  by  the  appropriate 
organs;  and,  second,  an  accelerated  production  of  healthier 
and  more  vigorous  cell  elements,  which  are  much  better  able 
than  their  predecessors  to  resist  toxaemia  and  microbic  inva- 
sion and  to  carry  on  the  function  of  tissue  reconstruction.  We 
not  only  obtain  a  corrective  influence  in  nutritional  and  con- 
stitutional disorders,  the  origin  of  which  is  in  the  trophic 
nervous  system,  but  if  the  patient  is  suffering  from  an  infec- 
tious invasion  we  increase  vastly  the  resisting  power  of  his 
phagocytes  and  tissue  elements.  The  profuse  perspiration 
carries  out  with  it  a  certain  amount  of  any  toxin  that  may  be 
present  and  thus  assists  in  relieving  depression  of  vital  nerve 
centers. 

The  functional  activity  of  every  organ  and  tissue  in  the  body- 
is  immediately  augmented,  but  this  exaltation  of  function  is 
not  followed  by  a  reactionary  debility  if  good  judgment  and 


28  Therapeutics  of  Dry  Hot  Air. 

proper  technique  have  controlled  the  administration.  Patients 
usually  continue  to  improve  in  health  and  strength  for  months 
after  a  course  of  body  dry  hot  air  treatments. 

The  physiological  action  of  this  measure,  then,  is  predomi- 
nantly reflex  through  the  sympathetic  and  spinal  nerve  centers, 
the  area  of  skin  treated  being  so  great  that  the  capillary  cir- 
culation is  able  to  dissipate  the  heat  before  it  penetrates  deeply 
enough  to  exert  its  action  directly  upon  the  underlying  struc- 
tures to  any  great  extent,  herein  differing,  as  we  shall  see,  from 
the  local  application. 

Sphere  of  Action. — When  we  consider  the  large  number 
of  pathological  conditions  which  are  dependent  wholly  or  in 
part  upon  the  occurrence  in  the  system  of  sub-oxidation,  and 
the  retention  in  the  circulation  and  tissues  of  its  products  or 
of  various  toxins  of  other  origin,  the  influence  of  the  body  dry 
hot  air  application  upon  oxidation  and  the  excretory  function 
assumes  an  interesting  significance ;  and  when,  in  addition,  we 
think  of  the  number  and  variety  of  diseases  in  which  the 
resistive  and  reconstructive  functions  are  deficient,  the  reflex 
nervous  phenomena  and  modifications  in  the  composition  of 
the  blood  noted  above  are  scarcely  less  attractive.  The  field  of 
usefulness  of  this  measure,  therefore,  extends  within  limits  of 
considerable  magnitude. 

LOCAL    APPLICATION. 

Elements  of  Physiological  Action. — This  therapeutical 
measure  affects  physiological  function  in  two  ways :  first,  by 
a  direct  stimulation  of  cell  metabolism  in  the  part  treated, 
due  to  the  raising  of  its  temperature  en  masse;  and,  second, 
by  reflex  acceleration  of  cell  nutrition  set  up  by  the  stimu- 
lating influence  of  the  heat  upon  the  numerous  nerve  endings 
in  the  skin. 

Temperature  Elevation  of  Part  Treated. — It  is,  of  course, 
not  possible  to  raise  the  temperature,  en  masse,  of  one  portion 
of  the  body  very  much  higher  than  that  of  the  rest  of  the 
organism,  but  by  placing  the  bulb  of  a  clinical  thermometer 
at  the  bottom  of  a  deep  sinus  and  then  applying  a  local  dry 
hot  air  treatment  it  has  been  demonstrated  that  an  increase 


Physiological  Action.  29 

of  about  twelve  degrees  Fahrenheit  can  be  induced.     This  is 
enough  to  accelerate  oxidation  processes  very  perceptibly. 

In  diseases  characterized  by  the  presence  of  pathogenic 
micro-organisms  in  the  part  treated,  as  local  septic  infection 
or  pneumonia,  the  inhibitive  influence  of  this  element  of  the 
physiological  action  upon  the  growth  and  activity  of  the  germs 
is  very  evident.  It  has  been  suggested  that  the  germs  in  these 
cases  were  directly  destroyed  by  the  heat,  but  this  view  is 
improbable ;  there  is  no  experimental  or  clinical  evidence  avail- 
able which  can  be  looked  upon  as  indicating  that  it  is  possible 
to  raise  the  temperature  of  any  portion  of  the  body  sufficiently 
high  to  render  such  a  result  attainable.  It  is  more  likely  that 
the  effects  are  produced  indirectly  through  augmentation  of 
cell  vitality  and  acceleration  of  local  metabolism. 

Reflex  Effects. — Through  the  reflex  influence  is  obtained 
an  emphatic  local  hyperaemia  which,  together  with  the  stimu- 
lation of  the  trophic  nerve  supply  of  the  part  treated,  results 
in  greatly  increased  local  nutrition. 

Copious  perspiration  appears  upon  the  region  treated  and 
in  greater  or  less  degree  upon  the  rest  of  the  body.  This  secre- 
tion is  strongly  impregnated  with  fatty  acids,  whatever  the 
disease  from  which  the  patient  is  suffering,  or  even  if  he  has 
no  disease  at  all.  If  a  toxin  is  being  elaborated  in  the  part 
treated  a  large  proportion  of  it  is  thus  eliminated  before  it 
enters  the  general  blood  current,  and  that  which  has  already 
entered  the  circulation  is  eliminated  in  direct  proportion  as 
the  perspiration  induced  upon  the  body  surface  is  profuse. 

To  these  profound  influences  upon  the  circulatory,  excretory, 
and  metabolic  functions  of  the  part  whereby  stasis  is  relieved, 
is  probably  due  the  powerful  effect  of  dry  hot  air  treatments 
in  relieving  pain  and  swelling. 

That  these  applications  are  sometimes  capable  of  exerting 
profound  reflex  influence  upon  parts  physiologically  related 
to  but  actually  distant  from  the  field  of  direct  administration, 
was  demonstrated  in  a  case  reported  by  Walsh.  The  patient 
had  eczema  of  both  hands;  one  only  was  subjected  to  the 
treatment,  yet  both  got  well.  Cases  also  have  been  reported 
where  pains  in  a  limb  on  one  side  of  the  body  have  been 


3O  Therapeutics  of  Dry  Hot  Air. 

relieved  while  the  corresponding  limb  on  the  opposite  side  was 
being  treated. 

It  will  be  observed  that  all  of  these  effects  tend  greatly  to 
increase  the  assimilation  and  absorption  of  remedies,  in  the 
tissues  wherein  such  effects  are  induced. 

General  Body  Temperature  and  Pulse. — These  are  rarely 
much  modified  by  the  local  application.  Patients  will  some- 
times exhibit  an  increase  of  a  fraction  of  a  degree  in  the 
former  or  an  acceleration  amounting  to  eight  or  ten  beats  per 
minute  in  the.  latter ;  modification  to  these  extents  is,  of  course, 
not  capable  of  influencing  the  general  metabolic  functions 
markedly. 

Sphere  of  Action. — The  influence  of  the  local  application, 
then,  is  practically  confined  to  the  part  treated.  What  effects 
are  produced  upon  the  organism  as  a  whole  are  principally  sec- 
ondary to  changes  induced  in  the  local  disease  focus;  hence 
it  will  not  and  should  not  be  expected  to  cure,  unaided, 
pathology  of  general  or  central  primary  causation.  For  in- 
stance, local  treatments  alone  will  not  cure  the  joint  lesions 
of  arthritis  deformans  because  these  lesions  are  but  secondary 
manifestations  of  impaired  general  trophic  functions;  they 
will  in  some  instances  relieve  the  pain  temporarily,  however. 
In  early  localized  septic  infection,  on  the  other  hand,  the  pri- 
mary pathological  focus  is  in  the  part  affected,  and  local  dry 
hot  air  treatments  will  usually  produce  a  rapid  and  radical 
cure;  the  organism  at  large  will  be  secondarily  benefited  during 
the  curative  process,  by  the  lessening  of  pain  depression  and  of 
the  quantity  and  virulence  of  the  toxins  elaborated  in  the 
original  pathological  focus,  in  direct  proportion  as  the  local 
lesion  improves. 

Summary  of  Physiological  Influences. 

General  Application. — First,  an  immediate  and  powerful 
stimulation  of  the  vital  physical  functions  which  is  evidenced, 
before  the  patient  leaves  the  apparatus  usually,  by  augmented 
vigor  of  the  heart  action  and  pulse  and  a  lessening  of  nervous 
erythism  when  such  is  present  as  a  result  of  acute  disease 
processes. 


Physiological  A  ct  ion .  3 1 

Second,  a  reflex  stimulation  of  the  functions  of  all  the  organs 
and  tissues  of  the  body  which  results  in,  a,  a  degree  of  elimina- 
tion of  urea  and  other  katabolic  excreta  probably  unequaled  by 
that  producible  with  any  other  measure  now  known ;  and,  b,  an 
amount  of  general  reconstructive  activity  which  would  also 
seem  to  be  in  excess  of  that  derivable  from  the  use  of  other 
agents. 

Local  Application. — First,  immediate  relief  of  circulatory 
stasis. 

Second,  increased  blood  supply  to  the  part  treated. 

Third,  acceleration  of  the  nutritive  processes  of  the  part  due 
to  reflex  stimulation  of  the  trophic  nerve  supply. 

Fourth,  an  increase  in  the  temperature  of  the  part  treated 
whereby  the  chemical  reactions  constituting  local  metabolism 
are  facilitated.  (It  is  probably  through  intensification  of  local 
physiological  resistance,  brought  about  by  the  four  above- 
mentioned  effects,  that  the  inhibitive  influence  upon  the  de- 
velopment of  pathogenic  micro-organisms  that  may  be  present, 
is  secured.) 

Fifth,  the  withdrawal  of  a  large  amount  of  fluid  from  the 
part  treated  by  reason  of  the  profuse  perspiration  induced. 

Clinical  Applicability. 

From  the  above  it  will  be  seen  that  the  pathological  condi- 
tions in  the  treatment  of  which  dry  hot  air  is  useful,  can  be 
divided  roughly  into  three  groups.  Although  this  division  is 
entirely  arbitrary,  yet  it  will  serve  to  furnish  a  bird's-eye  view 
of  the  field  of  action,  and  may  quicken  comprehension  of  its 
applicability  to  different  cases. 

First,  those  disease  conditions  in  which  the  essential  primary 
pathology  is  strictly  local  and  for  the  cure  of  which  the  local 
dry  hot  air  application  is  sufficient;  as  illustrations  may  be 
mentioned  sprains,  local  septic  infection  in  its  early  stages,  and 
many  cases  of  rheumatism. 

Second,  cases  wherein  the  essential  primary  pathology  is  local 
but  resultant  conditions  in  the  organism  at  large  have  compli- 
cated the  original  symptom  complex,  and  for  the  relief  of 
which  the  additional  influences  of  the  body  treatment  upon  the 


32  Therapeutics  of  Dry  Hot  A  ir. 

general  bodily  functions  must  be  invoked ;  local  septic  infection 
with  profound  systemic  toxaemia  is  a  good  illustration  of  this 
class. 

Third,  the  constitutional,  diathetic,  and  general  diseases,  in 
which  only  the  profoundly-acting  influences  of  the  body  treat- 
ment upon  general  metabolism  are  of  benefit.  As  illustrations 
may  be  mentioned  Bright's  disease  of  the  kidneys,  chronic  true 
gout,  and  arthritis  deformans. 

Analogies. 

It  will  be  observed  that  the  physiological  action  of  dry  hot 
air  is  made  up  of  most  of  the  integral  elements  which  also 
combine  to  form  the  physiological  actions  of  the  various  hydro- 
therapeutic  procedures,  electricity,  mechanical  vibratory  stimu- 
lation, massage,  etc.,  but  that  such  elements  as  are  common 
vary  in  the  proportion  of  intensity  with  which  they  manifest 
themselves  in  the  characteristic  influences  of  these  different 
remedial  measures;  hence  in  some  directions  dry  hot  air  is 
more  efficient  than  any  of  them.  It  is  frequently  advantageous, 
however,  and  as  will  be  seen  later  sometimes  necessary,  to  com- 
bine other  elements  of  therapeusis,  physiological,  medicinal, 
and  surgical,  with  dry  hot  air  in  order  to  accomplish  certain 
results.  None  of  them  alone  will  do  the  work  of  several  com- 
bined in  many  cases. 

The  mode  of  action  of  thermotherapeutical  influences  is  also 
directly  parallel  with  and  immediately  in  the  line  of  the  normal 
physiological  forces  concerned  in  cell  development  and  tissue 
reconstruction,  hence  the  only  pernicious  after-effect  to  be 
guarded  against  is  reaction  from  over-stimulation,  the  avoidance 
of  which  will  be  discussed  in  the  succeeding  chapter. 

Fallacies. 

As  to  Identity  of  the  Influences  Exerted  by  Hot  and  Cold 
Applications. — A  belief  is  more  or  less  current  that  the  effects 
upon  physiological  function  of  degrees  of  heat  and  cold  which 
depart  from  the  normal  body  temperature  to  the  same  extent  in 
their  respective  directions,  are  identical.  This  belief  is  based 
upon  a  conception  of  the  physiological  actions  of  such  applica- 


Physiological  Action.  33 

tions,  which  assumes  that  irritation  of  nerve  endings  in  the 
skin  constitutes  the  only  factor  involved. 

If  such  were  the  case  the  above-mentioned  belief  would 
undoubtedly  be  true,  but  reflection  shows  the  problem  to  be 
much  more  complicated.  The  gross  physiological  effects  of 
either  hot  or  cold  applications  are  made  up  of  at  least  three 
component  influences;  first,  that  obtaining  through  modifica- 
tions of  sensation  (including  psychic  impressions)  ;  second, 
that  obtaining  through  the  reflexes ;  and  third,  that  dependent 
upon  the  direct,  inherent,  physical  and  chemical  results  of  heat- 
ing or  chilling  body  tissues.  The  gross  physiological  influence 
being  a  composite  phenomenon  therefore,  the  operation  of 
factors  that  alter  the  nature  of  any  of  the  elemental  constituent 
influences,  or  change  the  proportionate  prominence  with  which 
they  enter  into  the  combination,  would  necessarily  modify  the 
physiological  result. 

To  convince  oneself  that  a  radical  difference  obtains  as 
regards  sensation,  it  is  only  necessary  to  immerse  the  hand  or 
foot  in  water  at  73°  F.,  and  after  the  member  has  fully  recov- 
ered immerse  it  in  water  at  123°  F.  (nearly  the  extreme  limit 
of  temperature  elevation  at  which  contact  with  water  can  be 
tolerated),  which  is  as  much  hotter  than  the  normal  as  the 
former  is  colder;  if  the  immersion  is  not  maintained  long 
enough  to  obtund  sensibility  the  deduction  will  offer  no  diffi- 
culties. 

Another  discrepancy,  suggested  by  the  preceding  paragraph, 
is  that  contact  with  water  can  be  tolerated  at  a  much  greater 
departure  from  the  normal  body  temperature,  in  the  direction 
of  cold  than  of  heat ;  more  than  twice  as  great  with  the  majority 
of  individuals.  This  discrepancy  involves  not  only  sensa- 
tion, but  the  actual  physical,  structural  integrity  of  the  tissues 
subjected  to  influence. 

To  demonstrate  a  substantial  difference  in  reflex  effects, 
immerse  the  feet  of  a  person  who  is  perspiring  freely  in  water 
at  73°  F.  for  a  few  seconds  and  note  what  a  lessening  in  the 
emunctory  process  takes  place;  conversely,  immerse  the  feet 
of  a  person  who  is  not  perspiring,  in  water  at  123°  F.  and  see 
the  perspiration  start. 


34  Therapeutics  of  Dry  Hot  A  ir. 

A  disparity  in  the  direct,  inherent,  physical  effects  produced 
by  actually  chilling  or  heating  body  tissues,  becomes  at  once 
apparent  to  anyone  who  has  observed  the  different  manner  in 
which  an  incarcerated  hernia  responds  to  the  two  applications. 
Such  a  disparity  is  also  well  illustrated  by  the  fact  that  super- 
ficial neuralgias  and  other  painful  conditions  are  sometimes 
relieved  by  hot  compresses  and  aggravated  by  cold,  and  vice 
versa. 

Nothing  conclusive  can  be  said  as  to  the  prominence  of  the 
first-mentioned  factor  as  a  modifying  element ;  it  has  not  yet 
been  determined  in  just  what  degree  or  manner  differences  in 
sensation  are  active  in  influencing  physiological  function.  We 
do  know,  however,  that  a  remedial  measure  that  is  not  un- 
pleasant to  the  patient  is  likely  to  produce  better  results  than 
one  which  is  unpleasant,  and  the  application  of  which  is  there- 
fore anticipated  by  him  with  dread.  The  therapeutical  appli- 
cation of  dry  hot  air  is  very  rarely  unpleasant  in  the  slightest 
degree,  that  of  cold  is  not  infrequently  fraught  with  torture 
both  mental  and  physical;  patients  usually  look  forward  with 
pleasure  to  the  former,  and  frequently  with  terror  to  the  latter. 

As  regards  the  reflex  tendencies  of  cold  and  heat,  it  is 
reasonable  to  infer  from  oft-observed  clinical  and  experi- 
mental findings,  that  they  are  exerted  in  the  same  directions 
as  are  the  direct  and  inherent  effects ;  i.  e.,  an  application  of  cold 
would  tend  primarily  to  affect  the  metabolism  and  nervous 
phenomena  of  the  area  influenced  as  would  cold  if  applied 
directly  and  long  enough  to  chill  the  parts ;  an  application  of 
heat  would  tend  primarily  to  affect  the  area  influenced  as  would 
an  actual  raising  of  its  temperature  en  masse. 

The  proposition  stated  in  the  foregoing  paragraph  assumes 
that  neither  the  heat  or  the  cold  is  applied  with  sufficient 
intensity  to  excite  protest  from  the  tissues  under  influence. 
The  precipitation  of  protest  would  introduce  the  element  of 
irritation  into  the  equation,  and  the  effects  of  pure  and  simple 
irritation  are  probably  identical,  whether  provoked  by  either 
heat  or  cold. 

The  direct,  inherent,  physical  effects  of  cold  and  heat  may  be 
indicated  as  follows : 


Physiological  Action.  35 

First,  chilling  a  body  tends  to  check  chemical  changes  going 
on  among  its  component  atoms ;  as  applied  to  the  human  body 
the  direct  inherent  effect  would  be  to  hinder  metabolism,  which 
involves  cell  and  tissue  reconstruction  as  well  as  destruction  or 
waste. 

Second,  heating  a  body,  on  the  contrary,  tends  to  facilitate 
chemical  changes  going  on  among  its  component  atoms ;  as 
applied  to  the  human  body  the  direct  and  inherent  tendency 
would  be  to  accelerate  metabolism,  which,  again,  involves  cell 
and  tissue  reconstruction  as  well  as  destruction  or  waste. 

Applying  these  principles  practically,  then,  we  find  that  the 
application  of  cold  to  the  body  brings  into  play  a  force  which 
is  antagonistic  to  normal  metabolism  and  catabolism,  nervous 
and  glandular  function,  as  represented  by  chemical  change  and 
the  facility  with  which  nerve  impulses  are  transmitted.  If  the 
application  is  sufficiently  intense,  the  organism  will  resist  at 
the  first  impact ;  if  contact  is  prolonged  sufficiently  to  overcome 
this  initial  resistance,  metabolic  processes  will  be  retarded  in 
direct  proportion  as  the  tissues  are  chilled.  After  the  inhib- 
itory effect  has  passed  away,  the  organism  will  endeavor  to 
overcome  or  make  up  for  the  effects  of  temporary  suspension 
of  vital  processes  by  temporarily  increasing  normal  processes 
and  functions ;  by  manifesting  reaction. 

The  stimulant  influence  of  cold  then,  is  constituted  solely 
and  entirely  by  this  tendency  toward  resistance  and  reaction, 
hence  the  degree  of  stimulation  obtainable  with  it  is  limited 
absolutely  by  the  vitality,  or  power  to  resist  such  antagonistic 
influences,  of  the  organism  under  treatment.  If  the  organism 
is  so  weakened  by  disease  or  any  other  factor  as  to  be  unable 
to  resist  with  a  requisite  degree  of  vigor,  depression  instead  of 
stimulation  will  result. 

The  application  of  heat  to  the  body,  on  the  other  hand,  brings 
into  play  a  force  and  induces  conditions  which  are  entirely  in 
harmony  with  the  normal  processes,  hence  there  will  be 
no  initial  resistance  and  no  temporary  paralysis  of  metabolism 
which  must  be  overcome  before  stimulation  (reaction)  sets  in. 
Its  influence,  being  inherently  in  harmony  with  normal  metabo- 
lism, is  accelerant  to  these  processes,  in  some  degree,  from  the 


36  Therapeutics  of  Dry  Hot  A  ir. 

start  and  continues  so  to  be  throughout  every  phase  of  action 
contingent  upon  its  sustained  application. 

,When  we  recall  that  in  the  great  majority  of  pathological 
conditions  the  human  organism  endeavors  to  rid  itself  of  dis- 
ability solely  and  entirely  through  accentuation  of  the  normal 
metabolic  processes,  the  deduction  as  to  the  relative  applica- 
bilities of  cold  and  heat  to  such  pathological  conditions  becomes 
immediately  apparent. 

Another  important  fact  exhibiting  a  prominent  therapeutical 
bearing  and  contingent  upon  the  foregoing,  is  that  cold  is 
directly,  inherently,  and  reflexly  inhibitive  to  elimination  as 
well  as  cell  production  and  increases  the  former  function  only 
secondarily  through  the  reaction  obtainable,  and  that  heat,  on 
the  contrary,  is  directly,  inherently,  and  reflexly  accelerant  to 
elimination,  primarily  and  throughout  the  whole  period  during 
which  it  may  be  applied. 

The  element  most  active  in  producing  the  immediate,  visible 
stimulation  of  the  vital  signs  obtainable  with  dry  hot  air,  how- 
ever, to  apply  the  foregoing  directly  to  our  immediate  subject, 
is  irritation  of  the  nerve-endings  in  the  skin  when  the  heat  has 
become  intense  enough  to  excite  protest  (reaction)  from  the 
deep  nerve  centers.  This  protest,  however,  is  not  against  an 
inherently  antagonistic  force  which  threatens  inhibition  and  it 
has  not  been  necessary  to  paralyze  normal  processes  in  order 
to  elicit  the  reaction,  hence  it  would  be  expected  to  act  more 
kindly  than  cold.  Further,  this  irritation  of  nerve-endings 
occurs  late  in  the  application  and  after  the  organism  has  been 
so  influenced  through  acceleration  of  its  vital  processes  as  to  be 
capable  of  more  efficient  reaction,  as  suggested  in  the  pre- 
ceding paragraphs;  the  gross  stimulation  obtainable  with  this 
agent  therefore  is  much  more  profound  than  when  cold  is 
employed. 

The  inference,  then,  that  the  gross  effects  of  cold  and  hot 
applications  are  identical  is  not  demonstrable  by  experiment, 
confirmable  by  clinical  experience,  or  defensible  by  any  line  of 
logic  based  upon  observed  physical  or  physiological  facts.  We 
are  justified  therefore  in  making  the  claim,  suggested  by  prac- 
tical experience,  that  radical  differences  exist  and  that  they 


Phys io logical  Action.  37 

demonstrate  that  dry  hot  air  has  a  place  in  the  treatment  of 
disease  that  no  other  known  measure  can  fill ;  that  to  secure  the 
best  therapeutical  results  these  differences  must  be  recognized, 
distinguished,  and  thoughtfully  considered  in  connection  with 
the  management  of  different  disease  processes. 

As  to  Identity  of  the  Effects  Producible  with  Dry  Hot 
Air  and  Hydrotherapy. — The  hydriatic  modalities  depend 
for  the  induction  of  their  various  influences  upon  the  bringing 
into  contact  with  the  skin  of  different  degrees  of  heat  and  cold 
through  the  medium  of  water  variously  manipulated.  As  far 
as  the  inherent  effects  of  heat  and  cold  are  involved  in  hydro- 
therapeutic  applications  all  that  has  been  said  in  the  preceding 
section  applies  equally  well  here,  but,  as  has  previously  been 
stated,  hydriatic  and  dry  hot  air  applications  are  not  directly 
comparable  because  practical  difficulties  render  it  impossible  to 
apply  the  same  degrees  of  treatment  intensity;  the  conditions 
surrounding  the  us_e  of  these  two  remedial  measures  therefore 
are  not  susceptible  of  identification  for  purposes  of  compar- 
ison. Further,  some  hydriatic  procedures  include  percussion, 
an  element  which  has  no  parallel  in  any  method  of  dry  hot  air 
therapy. 

The  practical  difficulty  which  obtains  in  those  hydrotherapeu- 
tical  procedures  involving  heat  consists  of  the  fact  that  nothing 
like  the  same  degree  of  treatment  intensity  can  be  applied  to 
the  skin  through  the  medium  of  water  as  through  the  medium 
of  air,  because  the  structural  integrity  of  this  tissue  is  seri- 
ously endangered  when  the  temperature  of  a  wet  application 
approaches  170°  F.  and  the  result  of  contact  at  212°  F.  needs 
only  to  be  mentioned  to  be  appreciated.  Air  can  safely  be 
applied  to  the  skin  at  400°  F.  and  sometimes  more  if  proper 
precautions  are  observed,  and  its  characteristic  and  most  desir- 
able effects  are  not  produced  at  a  temperature  lower  than 
300°  F. 

The  nearest  approach  to  a  parallel  which  dry  hot  air  therapy 
can  offer  to  percussive  hydrotherapy  is  when  a  dry  hot  air 
treatment  is  followed  by  mechanical  vibratory  stimulation,  and 
when  the  organism  has  had  its  metabolic  and  reflex  activities 
intensified  to  such  a  degree  as  obtains  after  a  dry  hot  air  appli- 


38  Therapeutics  of  Dry  Hot  Air. 

cation  it  would  seem  as  though  this  combination  would  dis- 
count the  hydriatic  modality  as  regards  intensity  of  both  local 
and  general  influence ;  this,  however,  is  a  matter  for  future 
observation  to  decide. 

As  regards  comparison  of  the  effects  of  general  cool  and 
cold  hydriatic  applications  and  dry  hot  air,  to  the  whole  or 
the  greater  part  of  the  body  surface,  no  one  who  has  ever  con- 
trasted the  appearance  of  a  typhoid  patient,  shivering,  cyanosed, 
and  with  weakened  pulse  after  a  bath  only  fifteen  or  twenty 
degrees  Fahrenheit  below  the  body  temperature,  with  that  of 
such  a  patient  who  has  been  given  a  body  dry  hot  air  treatment, 
will  any  longer  entertain  doubt  as  to  the  existence  of  a  radical 
difference  in  the  gross  effect  of  the  two  measures.  The  gen- 
eral dry  hot  air  application  never  produces  shivering  or  cya- 
nosis with  all  that  they  imply,  no  matter  whether  it  is  adminis- 
tered at  ten  or  three  hundred  degrees  above  the  normal  body 
temperature;  on  the  contrary,  the  sedative  influence  upon  the 
nervous  system  is  invariably  marked,  the  patient  usually  falling 
into  a  quiet  sleep  within  two  hours,  and  the  ruddy  glow  of  the 
skin,  warmth  of  the  extremities,  and  augmented  volume  and 
force  of  the  pulse  which  ensue  demonstrate  that  a  direct  and 
powerful  sedative  and  tonic  force  has  been  at  work. 

The  elucidation  of  the  variation  in  these  two  pictures  is  found 
in  the  fact  that  the  patient  who  is  cyanosed  and  responding 
badly  to  the  cold  bath  has  not  sufficient  vitality  to  react  ade- 
quately, while  the  influence  and  effect  of  the  general  dry  hot 
air  treatment  are  such  that  much  less  reactive  power  on  the 
part  of  the  patient  is  necessary  for  the  production  of  its  full 
effect ;  the  thermal  agent  furnishes  inherently  and  directly  the 
greater  part  of  the  effect  demanded. 

No  matter  how  carefully  and  conscientiously  the  hydrothera- 
peutic  treatment  of  typhoid  fever  is  carried  out  the  above- 
described  picture  not  infrequently  obtains,  and  we  have  seen 
profound  and  alarming  prostration  follow  twenty  minutes  of 
simple  cold  toweling  of  a  patient  in  bed  and  which  refused  to 
yield  to  strychnia  hypodermically,  whisky,  and  vigorous  rub- 
bing, overcome  at  once  by  fifteen  minutes  of  general  dry  hot  air 
at  300°  F. ;  a  very  good  practical  indication  that  the  measures 


Physiological  Action.  39 

exert  radically  different  influences.  In  addition  to  this,  typhoid 
patients  sometimes  complain  bitterly  of  the  hydriatic  applica- 
tion, but  I  have  never  heard  one  object  at  all  strenuously  to 
the  general  dry  hot  air  treatment ;  on  the  contrary,  they  usually 
like  and  feel  comforted  by  it. 

After  what  has  been  said  in  this  and  the  preceding  sections,  a 
statement,  which  has  been  published,  to  the  effect  that  dry  hot 
air  applications  are  "  not  complete  except  when  systematically 
employed  in  conjunction  with  hydrotherapy,"  will  need  but 
brief  discussion. 

The  profundity  and  intensity  characterizing  the  acceleration 
of  functional  and  general  metabolic  processes,  evoked  by  a 
thoroughly-aclministred  dry  hot  air  treatment,  is  limited  only  by 
the  inherent  capacity  of  the  organism  under  influence  for  carry- 
ing on  these  processes;  hence  they  could  not  be  further 
increased  by  the  application  of  any  other  force  acting  from 
without  the  organism,  and  certainly  not  by  a  force  which 
depended  for  its  stimulating  properties  upon  the  reactive 
capacity  of  such  organism.  If  the  dry  hot  air  were  not  intelli- 
gently and  thoroughly  administered  (as  when  the  degree  of 
heat  employed  is  not  sufficiently  intense,  etc.)  and  if  the  pa- 
tient's reactive  powers  were  adequate  it  would  be  obvious  that 
the  application  of  an  additional  stimulant  would  be  beneficial ; 
when  shortcomings  in  technique  are  eliminated,  however,  dry 
hot  air  rarely,  if  ever,  needs  to  be  followed  by  hydrotherapy  in 
order  that  its  beneficent  work  may  be  complete. 

This  does  not  mean,  however,  that  hydrotherapy  is  not  of 
value,  and  of  great  value,  when  combined  (alternated)  with  dry 
hot  air  applications;  on  the  contrary,  in  some  conditions  such 
employment  of  hydriatic  measures  is  of  the  greatest  assistance. 

As  to  the  Rationale  of  Its  Physiological  Influences.- — One 
of  the  most  prevalent  errors  in  the  popular  conception  of  the 
modus  operandi  of  the  curative  powers  of  dry  hot  air,  is 
that  it  produces  its  effects  merely  through  the  induction  of  in- 
tegumental  hypersemia  and  toxin  elimination  as  represented  by 
profuse  perspiration ;  this  has  led  to  applying  the  agent  at  tem- 
peratures only  sufficiently  high  to  produce  sweating,  that  is, 
from  200°  to  250°  F.  By  this  means  elimination  has  been  se- 


4O  Therapeutics  of  Dry  Hot  A  ir. 

cured,  and  very  effective  elimination,  too,  as  far  as  the  perspira- 
tory function  was  concerned,  but  that  was  all.  Now  to  obtain 
the  most  profound  and  permanent  curative  influences  of  dry  hot 
air,  we  must  not  only  induce  elimination  but  supplement  and 
perpetuate  as  far  as  possible  the  advantage  dependent  thereon, 
by  augmenting  the  trophic  reconstructive  functions  whereby  we 
increase  the  patient's  constitutional  resistance ;  and  effective 
stimulation  of  these  processes  is  not  possible  unless  the  higher 
temperatures,  from  300°  to  40x5°  F.,  are  used. 

As  to  Permanence  of  Results. — One  commonly  hears  it 
stated  that  the  curative  results  obtainable  by  the  use  of  dry 
hot  air  are  not  permanent.  This  criticism  is  largely  based 
upon  the  belief  that  dry  hot  air  is  only  a  palliative  measure, 
like  a  dose  of  morphine  in  painful  conditions,  for  instance, 
and  would  never  be  entertained  if  the  profound  influences 
upon  physiological  function  which  we  have  been  discuss- 
ing were  given  due  .consideration.  The  belief  was  origi- 
nally given  weight  by  the  observation  that  cases  of  rheumatism 
treated  with  dry  hot  air  alone  very  frequently  "  came  back/' 
but  this  merely  meant  that  the  disease  was  not  cured  because 
the  thermal  agent  was  not  properly  supported  by  the  simul- 
taneous administration  of  appropriate  drugs  in  appropriate 
dosage.  The  therapeutical  characteristics  exhibited  by  dry  hot 
air  consist  in  its  power  to  accomplish,  either  alone  or  in  com- 
bination with  other  indicated  agents,  that  which  it  is  impossible 
for  any  other  combination  of  agents  to  accomplish  without  its 
aid. 

Another  fact  bearing  upon  this  criticism  is  that  when  we  have 
carried  a  patient  through  an  attack  of  pneumonia,  typhoid, 
rheumatism,  or  any  other  disease,  except  where  the  aetiological 
factor  has  been  removed  surgically,  we  cannot  assure  him  that 
he  will  never  have  the  disease  again,  no  matter  what  curative 
agents  we  have  employed.  We  can  only  be  certain  that  this  one 
attack  has  been  extinguished.  If  appropriate  environmental 
and  constitutional  conditions  again  obtain  he  will  surely  have 
to  sustain  another  attack,  no  matter  how  perfect  may  have  been 
his  health  in  the  meantime.  When  men  no  longer  contend  with 
conditions  which  engender  habits  of  life  that  are  inconsistent 


Physiological  Action.  41 

with  their  perfect  physical  health,  then,  and  not  till  then,  shall 
we  be  immune  from  repeated  attacks  of  disease,  and  when  that 
millennium  has  arrived,  dry  hot  air  and  most  of  our  other  reme- 
dial agents  will  have  retired  to  the  oblivion  of  complete  desue- 
tude. 

In  closing  the  consideration  of  this  division  of  our  subject 
1  desire  to  emphasize  the  fact  that  the  key  to  the  attainment 
of  satisfactory  results  by  the  use  of  dry  hot  air  as  a  thera- 
peutic agent  is  the  same  as  with  any  other  remedial  measure, 
medicinal  or  otherwise,  viz.,  a  thorough  knowledge  of  the  phys- 
iological action  of  the  agent,  and  a  logical  consideration  of  the 
same  with  reference  to  the  pathology  of  the  individual  departure 
from  the  normal  for  which  a  remedy  is  being  sought. 


CHAPTER    III. 
TECHNIQUE. 

THE  difference  between  proper,  thorough  technique,  and  the 
reverse,  frequently  constitutes  the  difference  between  success 
and  failure  in  clinical  results;  hence  this  subject  is  a  very 
important  one  and  merits  close  study. 

The  current  idea  that  it  is  a  perfectly  easy  matter  for  any 
physician  to  secure  a  dry  hot  air  apparatus  and  successfully 
treat  his  patient,  without  any  special  knowledge  of  the  agent  or 
the  management  of  it  with  reference  to  different  pathological 
conditions,  is  entirely  erroneous  and  much  to  be  deplored. 
When  this  unfortunate  impression  has  been  eliminated  better 
results  may  be  looked  for  from  its  general  employment,  and 
appreciation  of  its  beneficent  powers  will  succeed  the  lack  of 
confidence  with  which  it  is  so  frequently  regarded  at  present. 
Inefficient  technique,  and  lack  of  adequate  familiarity  with  its 
physiological  action  and  clinical  possibilities,  whereby  it  has 
been  called  upon  to  produce  results  which  a  reasonable  degree 
of  enlightenment  upon  these  points  would  have  taught  should 
never  have  been  expected  of  it,  have  brought  upon  dry  hot  air 
a  vast  deal  of  undeserved  opprobrium. 

Methods  of  Preparation. — There  are  two  ways  of  giving 
treatments;  with  coverings  and  without. 

The  latter  method  is  based  upon  the  assumption  that  the 
perspiration  will  be  evaporated  off  from  the  skin  by  the  high 
degree  of  heat  as  soon  as  it  is  formed;  while  this  should  per- 
haps be  so  theoretically,  yet  experience  demonstrates  that  it 
does  not  always  take  place.  A  large  proportion  of  the  perspi- 
ration does  evaporate  immediately,  and  if  a  low  degree  of  heat 
(200°  to  250°  F.)  is  used,  the  administration  without  coverings 
is  very  satisfactory.  But  it  is  ordinarily  necessary  to  employ 
greater  intensities  (350°  to  450°  F.)  and  then  the  sweat-glands 

42 


Technique.  43 

functionate  so  copiously  that  the  secretion  is  not  all  vapor- 
ized immediately  and  the  residue  becomes  hot  enough  to 
blister. 

Employment  of  the  covering  obviates  this  danger;  as  it 
invests  the  skin  closely  the  perspiration  is  absorbed  by  it  as  fast 
as  it  collects  and  the  attenuation  of  the  secretion  effected  by 
distributing  it  through  the  meshes  of  the  fabric  facilitates  its 
conversion  into  steam  by  the  heat,  when  it  readily  diffuses  off 
into  the  air  surrounding  the  part  under  treatment. 

The  material  for  the  covering  should  be  loose-meshed  and  as 
absorbent  as  possible,  and  the  cheap  grades  of  Turkish  toweling 
have  given  me  greater  satisfaction  than  anything  else. 

It  has  been  urged  as  an  objection  against  the  use  of 
wrappings,  that  the  heat  would  be  dissipated  by  its  passage 
through  them  to  such  an  extent  that  although  the  treatment 
could  be  applied  at  a  much  higher  temperature  than  when  they 
were  not  used,  yet  the  layers  of  air  in  immediate  contact  with 
the  skin  would  not  exhibit  a  temperature  in  excess  of  that 
which  it  would  be  possible  to  apply  if  the  application  were  made 
to  the  bare  skin.  To  dispose  of  the  point  it  is  only  necessary 
to  insert  a  high-temperature  thermometer  between  the  layers  of 
the  wrapping  during  a  treatment,  remove  it  quickly,  and  note 
the  reading.  Again,  anyone  who  has  observed  the  methods 
when  given  side  by  side  cannot  fail  to  be  impressed  by  the 
variation  obtaining,  both  as  regards  therapeutical  influence  and 
the  comfort  of  the  patient. 

LOCAL   APPLICATION. 
Preparation. 

It  is  well  to  have  the  patient  remove  all  of  his  clothing  and 
don  a  flannelette  robe  or  suit  of  pajamas  in  which  to  undergo 
this  treatment;  he  is  thereby  enabled  to  go  home  in  dry  gar- 
ments instead  of  those  dampened  by  perspiration. 

Arms  and  Legs. — For  treating  these  members  and  portions 
thereof  the  Turkish  toweling  should  be  cut  into  strips  about 
seven  inches  wide  and  five  feet  long,  hemmed  and  rolled  like 
a  surgical  bandage.  It  is  applied  the  same  as  a  roller  bandage 


44  Therapeutics  of  Dry  Hot  Air. 

(Cut  X),  not  tightly,  but  closely  enough  to   obtain  even  and 
intimate  contact  between  it  and  the  skin. 

There  should  then  be  wound  about  it,  paying  especial  atten- 
tion to  the  creases  and  recesses,  a  line  of  tape  with  the  turns 
about  one  inch  apart  (Cuts  XI  and  XII)  ;  this  will  press  the 
toweling  down  upon  the  skin  where  the  original  application 
of  the  wrapping  has  failed  to  do  so,  making  the  contact  as 
perfect  as  possible. 

The  limb  is  then  ready  to  be  placed  in  the  apparatus,  after 
which  it  should  be  again  carefully  inspected  to  see  that  every- 
thing is  in  proper  position  before  the  heat  is  turned  on. 

Knee.— At  first  sight  the  apparatus  designed  especially  for 
treating  this  joint  would  seem  to  be  particularly  well  adapted 
for  its  purpose,  but  when  it  is  attempted  to  utilize  it  practical 
difficulties  present  themselves. 

In  this  machine  the  leg  is  supported  by  a  canvas  or  denim 
strip  passing  from  side  to  side  in  the  interior  of  the  hot  air 
reservoir,  upon  which  it  is  designed  that  the  posterior  surface 
of  the  joint  shall  rest.  It  will  be  found  that  when  the  perspira- 
tion starts  it  will  run  down  and  soak  into  the  wrapping  next  to 
the  popliteal  space,  and  will  be  confined  there  by  the  pressure 
of  the  canvas  strip  under  the  weight  of  the  leg.  Instead  of 
being  rapidly  diffused  off  into  the  air  in  the  cylinder  it  remains 
in  contact  with  the  skin,  and  the  constant  steaming  produced 
will  render  it  impossible  to  secure  the  desired  intensity  of  heat 
without  blistering. 

It  was  attempted  to  obviate  the  difficulty  by  having  two  ver- 
tical supports  made,  one  to  be  placed  at  the  distal  and  the  other 
at  the  proximal  end  of  the  apparatus  and  entirely  external  to 
it,  upon  which  the  leg  should  rest.  By  this  means  it  was  pos- 
sible to  do  away  with  the  supporting  strip  inside  of  the  reser- 
voir and  the  conditions  were  considerably  improved ;  blistering 
was  still  uncomfortably  frequent,  however.  Finally,  the  special 
knee  apparatus  was  discarded  altogether  and  the  general  local 
machine  substituted  with  eminently  satisfactory  results;  much 
better  in  fact  than  those  obtained  with  the  one  especially  de- 
signed for  the  joint  (Cuts  XII  and  XIII). 

Other  advantages  dependent  upon  treating  the  whole  of  the 


o 
K 
>, 


Technique.  55 

limb  below  the  kriee  as  well  as  the  joint  itself,  are,  first,  the 
greater  amount  of  reflex  trophic  influence  obtained  by  reason  of 
the  greater  area  of  skin  exposed,  whereby  the  total  number  of 
nerve-endings  stimulated  is  increased  two-  to  three-fold ;  and 
second,  the  greater  rise  of  temperature  producible  in  the  tissues 
about  the  joint,  hence  greater  acceleration  of  metabolism, 
through  the  heating  of  the  entire  return  circulation  from  the 
toes  upward. 

Knee  joints  which  it  is  desired  to  treat  with  dry  hot  air,  how- 
ever, are  sometimes  ankylosed  in  the  flexed  position,  which  ren- 
ders it  impossible  to  get  the  joint  into  the  general  local  appara- 
tus ;  that  specially  designed  for  the  knee  then  becomes  the  only 
one  available. 

The  joint  is  wrapped  with  three  thicknesses  of  Turkish-towel- 
ing strips  for  a  distance  of  ten  inches  above  the  patellar  and  the 
same  distance  below  this  point  (Cut  XI).  The  foot  is  then 
carried  through  the  cylinder  until  the  knee  joint  is  directly 
above  the  source  of  heat  and  resting  upon  the  hammock.  The 
flexible  attachment  for  closing  the  distal  end  is  fastened  about 
the  limb  six  or  eight  inches  below  the  knee  and  that  for  the 
proximal  end  at  the  same  distance  above  (Cut  XIV).  The 
heat  is  then  turned  on  and  run  up  as  high  as  the  patient's  tol- 
erance will  permit,  but  for  the  reasons  just  stated  this  will  rarely 
be  more  than  275°  F. ;  this  degree  of  heat  is  much  less  efficient 
than  350°  F.  and  not  infrequently  it  will  fail  altogether  in  pro- 
ducing the  desired  therapeutical  result. 

The  fact  that  an  efficient  special  knee  apparatus  is  not  at 
present  available,  however,  is  not  of  as  much  importance  as 
would  at  first  be  supposed.  The  class  of  arthritic  affec- 
tions in  which  the  general  local  apparatus  cannot  be  used  for 
treating  this  joint  is,  as  will  be  seen  later,  that  in  which  local  re- 
pair is  best  obtained  through  restorative  influence  exerted  upon 
the  general  system,  and  the  body  treatment  renders  the  use  of 
local  applications  unnecessary. 

When  the  shoulder,  hip,  abdomen,  lung,  or  lumbar  region 
is  to  constitute  the  field  of  operation  the  toweling  should  be 
cut  in  pieces  eighteen  or  twenty  inches  wide  and  five  feet  long ; 
when  folded  twice  so  as  to  make  three  thicknesses  such  a  piece 


56  Tlierapeutics  of  Dry  Hot  A  ir. 

presents  an  area  that  is  very  convenient  for  use  in  this  situa- 
tion. It  is  also  well  to  have  on  hand  three  or  four  pieces  of 
toweling  about  eighteen  inches  square  for  use  with  those  pa- 
tients who  require  but  a  single  thickness  of  the  wrappings. 

Shoulder. — When  adjusting  the  wrapping  to  this  region  it 
will  be  found  advantageous  to  locate  it  diagonally  with  a  cor- 
ner pointed  down  the  arm  (Cuts  XV  and  XVI)  and  to  com- 
mence the  winding  of  the  retaining  tape  at  the  lower  end. 

Although  tape  does  very  well  for  retaining  the  wrapping  in 
this  location  yet  it  will  be  found  that  cloth  straps  one  inch  wide, 
furnished  with  a  buckle  at  one  end,  and  about  five  feet  long 
will  be  found  more  satisfactory  in  most  cases.  After  the 
wrapping  has  been  located  as  above,  such  a  strap  is  passed 
around  the  body  immediately  below  the  armpits  so  as  to  in- 
clude that  portion  of  the  wrapping  which  is  folded  under  the 
axilla,  and  buckled  so  that  the  buckle  is  posterior  and  opposite 
the  median  line  of  the  back  between  the  shoulder  blades.  The 
free  end  of  the  strap  is  then  brought  over  the  wrapping  on  the 
shoulder  close  to  the  root  of  the  neck  and  pinned  to  that  por- 
tion of  the  strap  which  passes  over  the  sternum.  The  edges  of 
the  wrapping  about  the  upper  arm  are  then  drawn  together 
upon  the  inner  side  of  the  arm  midway  between  the  axilla  and 
the  elbow  and  pinned  together  with  a  safety  pin  (Cut  XVI). 
By  this  means,  slight,  uniform  tension  is  exerted  upon  the 
wrapping  all  over  the  area  to  be  treated  and  in  all  directions, 
and  no  constriction  of  the  blood-vessels  or  other  uncomfortable 
sensations  will  annoy  the  patient. 

As  with  the  knee  joint  a  better  therapeutic  result  can  be  at- 
tained if  the  whole  arm  as  well  as  the  shoulder  is  subjected  to 
influence  and  the  entire  return  circulation  of  the  arm  heated. 
When  deformities  or  motile  limitation  from  pain  is  not  pres- 
ent in  such  a  degree  as  to  prevent  carrying  the  arm  away  from 
the  body  so  as  to  get  it  into  the  cylinder  therefore,  the  wrap- 
pings used  should  consist  of  the  strips  and  their  application 
should  commence  at  the  finger  tips  and  be  extended  to  the  neck. 
The  proximal  end  of  the  cloth  attachment  should  then  be  ad- 
justed to  the  patient  sufficiently  high  up  to  include  the  shoulder, 
and  the  arm  rested  upon  the  hammock  inside  of  the  apparatus. 


Technique.  57 

The  special  chair  devised  by  the  author  and  described  in 
Chapter  I  will  be  found  very  helpful  when  administering  a 
treatment  to  the  shoulder. 

Hip. — The  same  suggestion  as  to  placing  the  wrapping  ap- 
plies when  the  hip  is  being  prepared  for  treatment,  and  in  this 
situation  also  the  cloth  straps  described  in  connection  with 
preparation  of  the  shoulder  will  be  found  better  than  tape  for 
holding  the  toweling  in  place  (Cuts  XVIII  and  XIX). 

Treatment  is  most  conveniently  administered  with  the  pa- 
tient lying  on  his  side  upon  a  couch,  the  hip  to  be  treated  being 
uppermost. 

Abdomen. — The  patient  is  brought  to  the  edge  of  the  bed, 
the  wrapping  placed  upon  the  abdomen,  and  retained  in  place 
by  webbing  straps  one  inch  broad,  long  enough  to  pass  clear 
around  the  body,  and  furnished  with  a  buckle  at  one  end ;  these 
are  passed  about  the  body  one  just  above  another  just  below  the 
iliac  crests. 

The  patient  is  then  turned  upon  his  side  facing  outwardly 
from  the  bed  and  a  pillow  placed  under  the  lumbar  region,  so  as 
to  prevent  the  sagging  of  this  portion  of  the  body  due  to  the 
projection  of  the  undermost  iliac  crest. 

When  this  position  has  been  attained  it  will  be  found  that  the 
webbing  straps  will  require  readjustment  in  order  that  good 
apposition  of  toweling  and  skin  may  be  maintained.  It  will 
also  be  found  that  the  sagging  of  the  abdomen  due  to  the  posi- 
tion has  caused  a  hollow  to  form  immediately  under  the  upper- 
most iliac  spine,  into  which  the  toweling  will  have  to  be  pressed 
by  crowding  a  napkin  under  the  retaining  strap  in  this  situa- 
tion (Cuts  XXVII  and  XXVIII). 

This  hollow  must  be  carefully  watched  during  treatment 
and  the  covering  frequently  pressed  down  upon  the  skin  by  the 
hand  of  the  operator,  or  blisters  will  sometimes  form  in  spite 
of  the  napkin. 

The  Chest  Wall  and  Lumbar  Region. — The  cloth  straps 
used  in  the  abdominal  operation  constitute  the  most  efficient 
means  of  maintaining  the  necessary  contact  between  wrapping 
and  skin  when  treatment  is  to  be  applied  over  the  lungs  or  the 
lumbar  region  (Cuts  XX,  XXI,  and  XXIII). 


58  Therapeutics  of  Dry  Hot  Air. 

When  the  chest  wall  of  a  woman  is  to  be  treated  one  of  the 
retaining  straps  should  be  passed  around  the  body  directly 
under  the  breast,  so  as  to  press  the  toweling  well  down  into  the 
hollow  formed  by  the  projection  of  this  part  of  her  anatomy. 
It  will  be  wise  to  press  the  toweling  frequently  against  the  skin 
in  this  situation  anyway  during  the  seance,  as  the  occasional 
impossibility  of  securing  close  contact  here,  even  with  a  well- 
applied  belt,  invites  a  tendency  toward  blister  formation. 

Amount  of  Wrapping  Necessary. — Just  the  right  amount 
of  covering  to  be  employed  will  be  determined  by  the  idiosyn- 
crasy of  the  individual  patient  as  regards  pro fuseness  of  perspi- 
ration, and  of  the  treatment  as  regards  the  intensity  of  heat,  etc., 
but  should  be  as  little  as  is  consistent  with  safety  of  the  integu- 
ment. At  least  one  thickness,  however,  should  cover  every 
part  of  the  area  exposed,  and  the  wrappings  should  be  boiled  in 
soap  and  water  after  each  application. 

Apparatus. — When  the  Betz  general  local  apparatus  is  em- 
ployed particular  care  should  be  exercised  to  see  that  the  heat 
carrier  entirely  covers  the  hole  in  the  bottom  of  the  cylinder 
through  which  the  hot  air  enters,  before  the  treatment  is 
started.  It  is  very  liable  to  become  displaced  when  the  ma- 
chine is  moved  and  when  displaced  the  thermometer  reading  is 
absolutely  unreliable  as  an  index  to  treatment  intensity  ;  further, 
the  proper  distribution  of  heat  to  all  parts  of  the  apparatus  is 
seriously  interfered  with  by  such  displacement. 

When  treating  portions  of  the  body  other  than  the  extrem- 
ities, the  supporting  hammock  inside  of  the  apparatus  is  of  no 
utility  and  had  better  be  removed  from  the  machine  altogether. 

Administration. 

After  the  wrappings  have  been  applied  the  cloth  attachment 
appropriate  to  the  region  which  is  to  be  treated  should  be  ad- 
justed, first  to  the  patient  and  then  to  the  apparatus,  and  the 
heat  turned  on. 

The  office  of  the  operator  during  the  treatment  resolves  itself 
into  four  functions,  as  follow : 

First,  attaining,  and  steadily  maintaining  a  temperature  in 
the  apparatus,  of  appropriate  elevation. 


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"H. 


Technique.  73 

Second,  changing  the  air  in  the  cylinder  often  enough  to 
maintain  dryness. 

Third,  guarding  against  ignition  of  the  wrappings  and  cloth 
fittings  of  the  apparatus. 

Fourth,  preventing  blister  formation. 

Accomplishment  of  the  first  involves  merely  allowing  the 
temperature  to  rise  steadily  until  the  desired  intensity  is 
reached,  where  it  may  be  maintained  by  regulating  the  heat 
supply. 

As  regards  the  second,  introducing  the  heated  air  directly 
into  the  cold  cylinder  will  provoke  condensation  of  moisture  to 
such  an  extent  as  to  necessitate  complete  ventilation  about  once 
•every  three  minutes  during  the  first  quarter  of  an  hour.  The 
little  valve  in  the  top  of  the  cylinder  is  not  large  enough  to  ac- 
complish this  efficiently  at  this  stage  of  the  application  and  the 
•object  is  best  attained,  unless  the  valve  has  been  enlarged  as 
described  in  Chapter  I,  by  slipping  from  the  cylinder  that  por- 
tion of  the  cloth  attachment  which  encircles  its  upper  segment, 
replacing  it  again  after  a  few  seconds  when  the  air  emerges  dry. 
After  the  machine  has  become  thoroughly  heated  no  more  in- 
convenience will  be  encountered  from  this  source,  and  opening 
the  valve  in  the  top  of  the  cylinder  occasionally  for  a  minute  or 
two  will  effect  all  the  ventilation  necessary. 

The  best  method  of  accomplishing  the  third  object  is  to  smell 
occasionally  of  the  air  that  escapes  from  the  cylinder  during 
ventilation;  the  odor  of  scorching  cloth  will  be  detectable  if 
danger  is  imminent. 

If  the  cloth  does  ignite  the  first  thing  to  do  is  to  turn  off  the 
heat,  then  remove  the  patient's  limb  from  the  apparatus  and 
dispose  of  the  smoldering  fabric.  If  the  mischief  is  taken  in 
hand  as  soon  as  the  odor  of  combustion  is  detectable  there  will 
IDC  ample  time  in  which  to  eliminate  the  difficulty  before  serious 
results  are  precipitated. 

Attainment  of  the  fourth  object  will  be  facilitated  if  the  con- 
ditions favoring  blister  formation  are  borne  in  mind,  as  fol- 
low: 

First,  the  presence  of  an  excessive  degree  of  moisture  in  the 
air  contained  in  the  cylinder. 


74  Therapeutics  of  Dry  Hot  A  ir. 

Second,  failure  in  maintenance  of  even  and  intimate  contact 
between  covering  and  skin,  due  to  inefficient  application  of  the 
wrapping  in  the  first  place,  or  to  movements  which  have  caused 
wrinkles  to  form,  on  the  part  of  the  patient.  Perspiration  col- 
lects upon  areas  ~of  skin  not  in  contact  with  the  absorbent, 
and  its  temperature  rapidly  rises  toward  the  boiling  point. 

Third,  interference  with  free  circulation  of  body  fluids  in 
the  part  under  treatment,  as  by  undue  tightness  of  the  wrap- 
pings, sclerotic  changes  in  the  vascular  structures,  etc. 

Unless  some  condition  of  the  patient's  tissues  is  present 
whereby  sensibility  is  obtunded,  a  threatening  blister  will  cause 
him  to  complain  of  a  "  burning  "  sensation ;  the  remedial  pro- 
cedures to  be  employed  when  such  warning  obtains,  then,  would 
be  as  follow: 

First,  ventilate  the  cylinder  rapidly  by  separating  from  it  the 
upper  portion  of  the  cloth  attachment;  if  this  procedure  does 
not  remove  the  discomfort  in  a  few  seconds  the  first-mentioned 
causative  condition  is  not  involved. 

Second,  introduce  the  hand  into  the  apparatus  and  press  the 
toweling  down  upon  the  complaining  area  of  skin,  when  im- 
mediate absorption  of  scalding  sweat,  and  relief  if  the  trouble 
is  due  to  this  factor,  will  follow. 

It  requires  a  little  practice  to  execute  this  maneuver  without 
burning  one's  hand;  the  knack  consists  in  getting  the  hand  in 
on  to  the  part  quickly,  and  quickly  out  again  without  touching 
the  sides  of  the  cylinder..  It  is  wise  for  a  beginner  to  wear 
a  cloth  glove  during  this  and  the  next-mentioned  procedure; 
it  will  save  him  much  discomfort  and  some  blisters  of  his 
own. 

Third,  introduce  the  hand  into  the  cylinder  and  loosen  the 
wrappings  about  the  complaining  region ;  if  they  are  too  firmly 
fixed  to  be  susceptible  of  requisite  manipulation  in  this  way,  re- 
move the  limb  from  the  apparatus  and  the  wrappings  from  the 
limb  and  reapply  them  more  loosely. 

When  sclerotic  changes  constitute  the  offending  element 
soaking  the  sensitive  areas  in  moderately  hot  water  for  ten 
minutes  before  treatment,  as  recommended  by  Ringer,  is  the 
only  efficient  remedy  with  which  I  am  acquainted.  If  this  does 


Technique.  75 

not  obviate  the  difficulty  it  will  be  necessary  to  treat  the  patient 
with  a  lower  degree  of  heat :  individuals  exhibiting  gangrenous 
tendencies  cannot  safely  be  subjected  to  more  than  200°  F. 
usually. 

Duration  and  Intensity  of  Stance. — The  local  treatment 
lasts  an  hour  usually;  less  than  this  is  not  enough,  and  more 
does  not  increase  the  effect  under  ordinary  circumstances. 

The  intensity  demanded  will  vary  from  300°  F.  to  400°  F., 
rarely  more  or  less. 

Both  duration  and  intensity  will  vary  according  to  the  condi- 
tions obtaining  in  the  individual  case,  and  will  be  discussed  in 
their  relation  to  different  pathological  states  in  the  sections 
which  treat  of  these  states.  . 

After-Care. — Wiping  the  perspiration  from  the  part  treated 
with  a  dry  towel  is  all  that  is  required  under  ordinary  circum- 
stances. Wrapping  the  part  in  flannel  or  cotton,  as  is  some- 
times recommended,  is  very  rarely  called  for.  Conditions  ex- 
ceptional to  these  rules  will  be  so  noted  in  the  sections  which 
treat  of  the  diseases -in  which  they  occur. 

External  Auditory  Canal. 

The  writer  has  had  no  personal  experience  with  the  use  of 
dry  hot  air  in  this  region,  and  the  following  description  of  the 
technique  pertaining  to  the  Hopkins  generators,  is  taken  ver- 
batim from  one  of  the  inventor's  articles  upon  the  subject. 

Management  of  the  Apparatus. — "  (i)  When  the  appli- 
ance becomes  hot  and  exit  is  through  a  small  opening,  as  in  an 
ear-tip,  the  temperature  of  the  air  is  proportional  to  the  rate 
of  flow,  or  degree  of  air  pressure.  Strange  as  it  may  seem, 
the  air  temperature  may  be  increased  one  hundred  degrees  by 
increasing  the  pressure  five  pounds,  or  conversely,  the  tem- 
perature may  be  decreased  by  lowering  the  pressure.  This 
fact  enables  us  to  regulate  the  temperature  at  will  by  merely 
increasing  or  decreasing  the  volume  of  air  entering  the 
cylinder. 

"  (2)  The  air  temperature  drops  very  rapidly  after  the  air 
leaves  the  exit-nozzle,  and  in  order  to  secure  the  maximum  heat 
the  part  under  treatment  must  be  as  near  the  nozzle  as  possible 


76  Therapeutics  of  Dry  Hot  A  ir. 

and  still  allow  room  for  escape  of  the  used  air,  if  a  cavity  like 
the  ear  is  under  treatment. 

Preparation  of  the  Patient. — "  The  ear  selected  for  treat- 
ment is  carefully  £xamined  and  found  to.be  perfectly  clean  and 
dry.  A  light  pad  of  gauze  (two  thicknesses)  is  placed  over  the 
ear  and  with  an  ear  speculum  the  gauze  is  pressed  deeply  into 
the  canal,  leaving  only  room  enough  between  the  tip  and  the 
tympanum  for  the  escape  of  the  used  air. 

Administration. — "  The  electricity  is  then  turned  on,  or  the 
gas  ignited  (as  the  case  may  be)  and  the  compressed  air  is 
admitted  to  the  cylinder  under  about  five  pounds'  pressure.  It 
is  well  to  give  a  ten  or  fifteen  minutes'  seance,  increasing  the 
temperature  gradually  until  the  limit  of  toleration  is  reached. 
The  temperature  steadily  increases  until  the  heater  reaches 
its  generating  limit  at  that  air-pressure,  and  if  the  patient 
tolerates  the  temperature  well  it  may  be  further  increased  by 
raising  the  air  pressure  to  seven,  eight,  or  even  ten  pounds,  in 
most  cases.  One  cannot  be  guided  by  thermometers  in  giving 
these  treatments,  and  hence  they  are  not  employed  on  the  new 
heater  described.  The  only  guide  which  can  safely  be  followed 
is  the  individual  toleration  of  the  patient.  But  it  is  well  to 
remember  that  the  more  slowly  the  temperature  is  raised  the 
higher  temperature  the  patient  can  endure  without  discomfort." 

"  Treatments  are  best  given  three  times  a  week  for  from 
three  to  twelve  months." 

GENERAL    APPLICATION. 
Preparation. 

A  loose  bath-robe  made  of  Turkish  toweling  constitutes  the 
best  covering  to  use  during  the  body  treatment. 

The  patient  may  assume  any  position  agreeable  to  him,  but 
as  it  is  necessary  that  he  remain  quiet  and  not  move  his 
limbs  about  during  the  application,  lying  upon  the  back  is  pref- 
erable unless  deformities  are  present  which  render  the  posi- 
tion irksome. 

Small  pillows  are  placed  under  the  hollow  parts  of  the  body 
so  as  to  give  it  support  without  strain. 


Technique.  79 

Boots  made  of  the  same  material  as  the  robe  and  coming 
to  the  knees  are  pulled  on  over  the  feet ;  if  the  hands  are  to  be 
included  in  the  application  they  should  be  encased  in  mittens 
of  Turkish  toweling. 

The  robe  is  then  pressed  down  between  the  legs  and  arranged 
so  as  to  hug  the  skin  closely,  and  the  patient  directed  not  to 
move  his  legs  about  after  this  has  been  done. 

Enough  medium-sized  Turkish  towels  are  then  spread  over 
the  feet,  legs,  and  abdomen  to  form  three  thicknesses,  the 
apparatus  closed  by  dropping  the  curtain  or  curtains,  and  tuck- 
ing them  in  closely  about  the  patient.  The  inside  of  the  appa- 
ratus should  then  be  inspected  to  see  that  no  towel  or  other  in- 
flammable object  has  dropped  into  it,  and  the  heat  turned  on. 

Just  the  right  amount  of  covering  to  be  used  will  be  deter- 
mined by  the  idiosyncrasy  of  the  patient  as  regards  profuse- 
ness  of  perspiration  and  nervous  sensibility,  and  of  the  appa- 
ratus as  regards  the  degree  of  heat  used  in  the  treatment,  etc., 
but  should  be  as  little  as  is  consistent  with  the  safety  of  the 
integument.  Very  frequently  the  robe  alone,  which  consti- 
tutes one  thickness,  will  be  sufficient;  in  other  cases  it  will  be 
necessary  to  cover  a  portion  only  of  the  body,  as  the  feet,  ab- 
domen, or  thighs,  with  the  extra  towels.  The  patient's  sensa- 
tions are  a  pretty  safe  guide  in  the  matter. 

Administration. 

The  body  area  exposed  to  the  heat  should  usually  be  the 
feet,  legs,  and  abdomen  up  to  a  point  midway  between  the 
umbilicus  and  the  nipple  line,  but  it  may  be  extended  so  as 
to  embrace  the  whole  body  up  to  the  neck.  The  factor  which 
determines  whether  or  not  the  whole  body  up  to  the  neck 
shall  be  subjected  to  influence  is  the  degree  of  response  obtained 
from  the  nerve  centers  during  the  seance,  and  this  also  governs 
the  length  and  intensity  of  the  application. 

Different  individuals  exhibit  different  degrees  of  suscepti- 
bility to  thermic  stimulation  and  each  patient  must  be  handled 
according  to  his  own  law.  Observation  and  experience  have 
shown  that  this  factor  is  tangibly  and  conveniently  expressed 
under  ordinary  circumstances  by  the  degree  of  acceleration  of 


80  Therapeutics  of  Dry  Hot  Air. 

the  pulse  and  increase  in  the  body  temperature  which,  as  we 
have  seen  in  the  preceding  chapter,  accompany  its  applica- 
tion. The  modifications  in  the  character  of  the  respiratory 
function  exhibit  too  much  irregularity  to  be  of  value  as  indices 
of  responsiveness  to  stimulation. 

The  pulse  and  temperature  then  being  adopted  as  guides,  it 
becomes  necessary  to  know  the  degree  of  acceleration  and  in- 
crease, respectively,  which  must  be  attained  in  order  that  the 
amount  of  deep  reflex  response  which  will  produce  the  best 
results  may  be  known  to  have  been  induced,  and  from  a  study 
of  four  thousand  body  treatments  given  under  my  personal 
supervision  I  have  adopted,  as  a  working  rule,  the  plan  of 
treating  the  patient  until  his  pulse-rate  has  increased  to  120 
beats  per  minute,  or  his  mouth  temperature  is  2  degrees  F. 
above  the  normal.  One  of  these  modifications  will  be  attained 
first  in  one  patient  and  the  other  in  the  next  perhaps,  but  the 
attainment  of  either  one  usually  means  that  a  sufficient  influence 
has  been  secured  and  that  the  time  has  come  to  stop  the  treat- 
ment. This  rule  is  of  course  subject  to  modification  according 
to  the  conditions  surrounding  the  individual  case. 

I  will  say  here  that  the  mere  induction  of  perspiration,  how- 
ever profuse,  is  not  an  indication  that  a  requisite  degree  of 
influence  has  been  secured ;  comparatively  low  degrees  of  heat 
will  often  do  this.  What  we  want  is  the  deep  reflex  response, 
hence  the  necessity  for  intelligently  thorough  treatment.  Pa- 
tients not  treated  up  to  this  point  do  not  get  their  due  in  the 
way  of  benefit,  and  if  it  is  carried  much  farther  the  nervous 
system  ordinarily  shows  signs  of  over-stimulation  which  is 
nearly  as  bad. 

Sometimes  the  application  will  be  completed  in  fifteen  min- 
utes, sometimes  it  will  require  an  hour. 

When  acceleration  of  pulse  and  increase  of  body  temperature, 
are  already  present,  as  with  some  acute  febrile  conditions,  this 
rule,  of  course,  possesses  no  value  and  the  general  effect  upon 
the  patient's  nervous  system  must  govern  duration  and  inten- 
sity, care  being  taken  not  to  over-stimulate. 

Phenomena  sometimes  induced  during  treatment  and  which 
demand  attention  are  nausea  or  retching,  faintness,  laryngeal 


Technique.  81 

cough,  oppression  of  breathing,  headache,  cranial  throbbing, 
ringing  in  the  ears,  uncertainty  or  partial  loss. of  vision,  and 
mental  confusion.  The  first  four  are  evidences  of  hyper-ex- 
citability of  the  nerve-centers  and  are  ordinarily  met  with  only 
in  hysterical  subjects;  the  occurrence  of  the  others  indicates 
cerebral  congestion  and  usually  means  that  the  limit  of  treat- 
ment duration  and  intensity,  consistent  with  the  patient's  best 
good,  has  been  reached.  All  of  these  phenomena  are  evidences 
of  relatively  excessive  stimulation. 

The  remedy  consists  of  the  application  of  an  ice-cap  to  the 
patient's  head,  which,  with  moderate  fanning  of  the  exposed 
portions  of  the  body,  will  usually  take  care  of  the  situation  per- 
fectly. If  the  symptoms  persist  in  spite  of  these  remedies  the 
heat  should  be  turned  off,  the  patient  cooled,  and  at  the  next 
seance  the  temperature  should  be  run  up  more  slowly.  I  have 
seen  but  one  patient  who  could  not  take  the  limit  if  handled 
well  and  he  was  a  victim  of  angina  pectoris ;  the  pain  was  al- 
ways provoked  when  the  pulse-rate  reached  no,  but  it  also 
always  subsided  kindly  as  soon  as  the  heat  was  turned  off  and 
the  pulse-rate  had  lessened. 

Water  may  be  given  at  any  time  during  the  treatment  in 
dessert-spoonful  doses  every  thirty  seconds  if  the  patient  devel- 
ops thirst,  but  should  not  be  administered  in  large  quantities 
at  once. 

Prevention  of  Accidents. — As  regards  scalds,  burns,  etc., 
the  same  causative  factors,  cautions,  and  means  of  prevention 
apply  here  as  were  mentioned  when  administration  of  the  local 
application  was  considered,  and  to  avoid  repetition  the  reader 
is  referred  to  that  section  for  this  information.  If  changing 
the  air  or  pressing  the  covering  against  the  skin  does  not  relieve 
the  burning  sensation,  open  up  the  apparatus  and  spread  an- 
other towel  over  the  complaining  spot.  Xo  matter  what  appa- 
ratus is  used,  if  the  heat  is  intense  enough  blisters  are  liable  to 
obtain,  and  constant  care  should  invariably  be  exercised. 

The  management  of  the  toes  during  a  body  treatment,  how- 
ever, sometimes  assumes  a  prominence  which  renders  it  worthy 
of  special  mention.  The  first  thing  to  do  when  a  patient  com- 
plains of  discomfort  affecting  these  members  is  to  change  the 


82  Therapeutics  of  Dry  Hot  Air. 

air  in  the  apparatus,  which  will  dispose  of  whatever  steam  may 
have  collected,  and  direct  the  patient  to  move  his  toes  gently 
backward  and  forward  against  the  wrappings,  but  without 
raising  his  heels  or  knees  from  the  couch. 

If  this  procedure  does  not  remove  the  difficulty,  open  up  the 
apparatus  and  loosen  the  wrappings  about  the  suffering  mem- 
bers ;  this  measure  will  always  prove  effective  unless  some 
mechanical  interference  with  the  circulation  of  the  parts,  such 
as  atheroma,  sustains  a  causative  relation. 

If  the  last-mentioned  causation  is  responsible,  soaking  the 
feet  in  moderately  hot  water  for  ten  minutes  immediately  be- 
fore treatment,  as  recommended  by  Ringer,  will  sometimes  pre- 
vent the  annoying  sensation. 

If  it  persists  in  spite  of  the  use  of  all  of  these  meas- 
ures, however,  it  will  be  necessary  to  resort  to  the  radical  plan 
of  treating  the  patient  with  his  feet  outside  of  the  cylinder 
entirely,  the  curtains  closing  the  pedal  end  being  tucked  closely 
about  his  ankles. 

Leaving  the  feet  outside  does  not  detract  in  the  least  from 
the  efficiency  of  the  treatment  even  when  the  disease  process 
is  located  in  these  members.  As  has  been  stated  when  consider- 
ing the  physiological  action  of  the  body  treatment,  its  influence 
"  is  predominantly  reflex  through  the  sympathetic  and  spinal 
nerve  centers,"  hence  the  profundity  of  that  influence  is  directly 
proportional  to  the  number  of  nerve-endings  exposed  to  the 
thermal  stimulation;  the  number  of  those  present  in  the  skin 
of  the  feet  bears  such  a  small  proportion  to  the  number  present 
in  the  skin  of  the  rest  of  the  body  that  practically  it  may  safely 
be  disregarded  in  this  connection.  Clinically  I  have  never  been 
able  to  perceive  that  it  made  any  difference  whether  the  feet 
were  inside  or  outside  of  the  apparatus,  except  in  so  far  as 
that  it  was  possible  to  treat  the  hyper-sensitive  patient  with  a 
higher  degree  of  heat  when  the  feet  were  outside,  hence 
modification  of  metabolism  was  more  marked. 

With  patients  in  whom  atheroma  is  present,  and  is  threaten- 
ing, or  has  already  eventuated  in  gangrene,  the  desirability  of 
preserving  the  toes  from  blistering  is  urgent.  Under  these 
conditions  any  traumatic  solution  of  integrity  in  threatened 


Technique.  83 

tissues  is  liable  to  inaugurate  the  gangrenous  process,  and  my 
appreciation  of  that  fact  has  been  rendered  poignant  from  hav- 
ing had  the  misfortune  to  see  it  demonstrated  in  my  own  prac- 
tice. A  man  seventy  years  old  was  under  treatment  for  exten- 
sive senile  gangrene  of  one  foot,  the  other  being  unaffected. 
The  great  toe  of  the  sound  foot  was  blistered  while  undergoing 
a  body  treatment  at  300°  F.,  and  gangrene  became  established 
in  the  blistered  area  in  about  a  week ;  this  experience  led  me 
to  adopt  the  practice  of  never  treating  the  feet  of  a  patient 
exhibiting  gangrenous  tendencies  at  a  temperature  exceeding 
200°  F. 

I  have  seen  patients  with  such  tendencies  in  whom  sensibility 
was  so  obtunded  that  they  would  blister  without  having  ex- 
perienced the  warning  of  discomfort  at  all,  hence  it  is  very 
necessary  to  handle  these  cases  with  the  utmost  circum- 
spection. It  is,  however,  very  desirable  to  induce  the  full 
physiological  effect  of  the  measure  upon  them  and  leaving  the 
feet  outside  renders  it  possible  to  apply  the  agent  as  energeti- 
cally as  may  be  desired.  The  other  portions  of  the  body  never 
give  trouble  of  this  sort  that  cannot  be  overcome  in  some  of 
the  ways  previously  suggested. 

Intensity  and  Duration  of  S6ance. — It  is  believed  by  some 
operators  that  as  long  as  the  requisite  increase  in  the  body 
temperature  and  acceleration  of  the  pulse-rate  are  secured,  it 
does  not  matter,  as  far  as  the  therapeutical  effect  is  con- 
cerned, whether  the  patient  is  treated  for  a  long  period  of  time 
with  a  low  degree  of  heat (250°  F.)  or  for  a  short  period  with 
a  high  intensity  (375°  F.). 

The  writer's  experience  has  not  led  him  to  concur  in  this 
conclusion,  neither  does  it  seem  to  him  that  the  philosophy  of  the 
position  is  well  founded.  Experience  shows  that  exposure  to 
a  low  degree  of  heat  (200°  to  250°  F.)  requires  a  much  longer 
time  in  which  to  produce  the  requisite  modifications  in  the 
body  temperature  and  pulse  in  the  majority  of  cases,  and  that 
in  some  it  is  absolutely  impossible  to  attain  them  at  all  with 
low  intensities.  It  also  shows  that  physical  exhaustion  which 
sometimes  lasts  for  many  hours  not  infrequently  follows  treat- 
ment so  administered.  Further,  those  who  advocate  this  form 


84  Therapeutics  of  Dry  Hot  Air. 

of  administration  also  advocate  following  the  dry  hot  air 
application  with  a  cold  douche,  which  indicates  that  a  satisfac- 
tory degree  of  vital  stimulation  does  not  ordinarily  result  from 
the  long  exposure  to  a  low  degree  of  heat.  It  is  also  this  class 
of  observers  principally  who  incline  to  the  belief  that  the 
beneficial  effect  of  dry  hot  air  applications  is  confined  to  the 
results  of  hyperidrosis  and  superficial  hypersemia. 

On  the  other  hand,  when  the  treatment  of  high  intensity  is 
used,  the  requisite  degree  of  modification  in  the  physiological 
phenomena  is  attainable  in  about  half  the  time  required  by  the 
reverse  procedure,  and  it  is  almost  never  impossible  to  secure 
this  requisite  degree  of  modification.  Instead  of  physical 
exhaustion  following  the  treatment  we  nearly  always  observe 
a  marked  exhilaration  which  lasts  for  hours  and  renders  the 
use  of  the  cold  douche  entirely  superfluous. 

As  far  as  actual  acceleration  of  the  bodily  metabolism  is 
concerned,  and  entirely  aside  from  the  patient's  subjective  sen- 
sations, I  would  say  that  the  comparative  determinations  as 
regards  the  urinary  constituents  made  by  us  up  to  the  present 
time,  indicate  a  constantly  greater  degree  as  resulting  from  the 
use  of  the  higher  temperature  with  shorter  exposure. 

If  the  increased  oxidation  in  the  tissues  of  the  body  was 
solely  dependent  upon  the  actual  increase  in  its  temperature  en 
masse  effected  by  the  dry  hot  air  application,  then  of  course 
the  long  exposure  and  low  intensity  of  heat  would  produce  the 
same  acceleration  of  metabolism  as  the  short  exposure  and 
high  intensity,  provided  that  the  exposure  to  the  low  degree  of 
heat  was  continued  long  enough  to  increase  the  body  temper- 
ature to  the  same  extent;  because  of  the  greater  total  length 
of  time  during  which  some  elevation  of  the  body  temperature 
would  necessarily  be  sustained  under  the  latter  method,  it 
might  be  even  greater. 

But  it  must  be  borne  in  mind  that  this  is  only  one  element 
in  the  equation,  and  that  probably  by  far  the  greater  portion 
of  the  increase  in  oxidation  (metabolism)  is  due  to  reflex 
stimulation  of  the  spinal  nerve  centers  through  thermic  irrita- 
tion of  the  nerve-endings  in  the  skin.  Through  this  stimula- 
tion is  secured  an  augmented  functionation  of  the  organs  and 


Technique.  85 

tissues  in  which  the  spinal  distributions  ramify,  hence  that  form 
of  treatment  which  effects  the  greater  stimulation  ought  to 
produce  the  greater  degree  of  metabolic  acceleration;  the  ob- 
servations of  the  writer  would  indicate  that  the  application  of 
short  duration  and  high  intensity  did  both. 

The  difference  in  the  effects  of  these  two  methods  of  appli- 
cation can  scarcely  fail  to  make  itself  evident  as  a  difference 
in  the  influence  secured  upon  the  trophic  and  glandular  func- 
tions and  the  physiological  resistance  of  the  patient,  and  this 
variation  would  be  important  in  proportion  as  the  necessity 
for  sharply-defined  influence  was  urgent.  In  pneumonia,  pro- 
found septic  infection,  Bright's  disease,  etc.,  the  question  would 
assume  an  aspect  of  prominence ;  it  has  therefore  been  con- 
sidered of  sufficient  moment  to  justify  discussion  at  some 
length. 

After-Care. — The  management  of  a  patient  who  has  had  a 
thorough  body  treatment  is  somewhat  important.  Our  cus- 
tom is  to  leave  him  in  the  closed  apparatus  for  ten  minutes 
after  stopping  the  heat,  then  open  up  the  apparatus  and  allow 
him  to  cool,  exposed  to  the  air  of  the  room,  for  twenty  minutes. 
Usually  by  this  time  the  body  temperature  and  pulse  will  have 
returned  to  the  normal.  The  pulse  usually  subsides  more 
slowly  than  the  temperature,  but  the  patient  should  not  be 
allowed  to  rise  until  it  has  nearly  or  quite  reached  the  rate 
which  obtained  before  treatment,  or  syncope  is  liable  to  result. 
One  of  my  early  patients  frightened  me  sorely  before  I  had 
learned  this  point,  by  falling  in  a  heap  on  the  floor,  unconscious 
and  cyanosed,  on  her  way  from  the  apparatus  to  the  bath ;  I 
had  gotten  her  up  too  soon. 

When  the  pulse  has  subsided  the  patient  may  rise  to  the 
sitting  posture  and  see  if  the  exertion  causes  nausea,  faintness, 
or  giddiness;  if  it  does  he  should  lie  down  again  for  ten  min- 
utes more.  If  not,  he  may  slowly  and  deliberately  leave  the 
apparatus  and  sit  in  a  chair,  preferably  one  which  can  be  in- 
stantly adjusted  to  the  reclining  position  if  any  giddiness  or 
nausea  is  provoked.  If  no  untoward  symptoms  appear  within 
three  or  four  minutes  he  is  ready  to  be  taken  to  the  tepid  bath, 
well  soaped,  rinsed  and  put  to  bed.  He  should  then  have  a 


86  Therapeutics  of  Dry  Hot  Air. 

thorough  rubbing  with  alcohol  and  be  left  to  sleep  or  rest  for 
an  hour,  after  which  he  may  dress. 

With  patients  who  are  unable  to  get  up  and  about,  the  bath 
will,  of  course,  have  to  take  the  form  of  a  "  sponge  "  and  may 
be  given  either  upon  the  couch  of  the  apparatus  or  after  the 
patient  has  been  removed  to  his  bed.  The  sole  object  of  the 
soap  and  water  bath  is  removal  of  the  perspiratory  accumu- 
lations ;  the  alcohol  rub  which  follows  is  locally  stimulant  and 
generally  comforting. 

In  some  diseases  characterized  by  a  marked  element  of  ner- 
vous debility,  as  arthritis  deformans  and  various  neurasthenic 
conditions,  it  is  well  to  prolong  the  period  of  rest  following  the 
alcohol  rub  to  three  or  four  hours. 

In  General. 

Frequency  of  Administration. — This  factor  varies  with 
different  diseases  and  conditions  and  will  be  indicated,  together 
with  advantageous  modifications  of  the  technique,  in  the  sec- 
tions which  treat  of  these  diseases. 

Intermissions  in  Treatment. — In  chronic  diseases,  as 
arthritis  deformans  or  chronic  nephritis,  it  is  desirable  to  sus- 
pend active  treatment  at  intervals  after  the  patient  has  once  been 
gotten  thoroughly  under  influence,  and  allow  his  natural  vital 
powers  to  carry  on  their  work  of  their  own  stimulated  volition 
as  long  as  recuperative  ability  is  manifest.  In  the  majority 
of  disease  processes  a  patient  is  able  to  recover  his  health  only 
through  the  agency  and  by  the  exercise  of  these  powers,  and 
dry  hot  air  applications  simply  augment  them,  thereby  invest- 
ing the  various  elements  of  the  organism  with  the  capacity  for 
more  vigorous  functionation.  After  such  functional  augmen- 
tation has  once  been  induced  then,  it  is  just  as  well  to  let  mat- 
ters alone  until  the  physiological  processes  manifest  the  need  of 
more  help. 

Most  patients  are  also  susceptible  of  being  benefited  by  a 
change  in  their  surroundings  when  such  change  does  not 
involve  disagreeable  or  detrimental  conditions,  and  when  one 
has  been  treated  in  a  sanitarium  for  weeks  or  months,  as  many 
of  them  will  have  to  be  if  they  get  the  most  out  of  the  thera- 


Technique.  87 

peutical  regime,  a  subjection  to  different  psychological  influ- 
ences will  frequently  do  much  to  intensify  and  perpetuate  the 
restorative  tendencies  of  the  actively-applied  remedial  measures. 
Burns. — A  proper  acquaintance  with  the  technique  and  ade- 
quate attention  paid  to  its  execution,  will  render  severe  burns, 
scalds,  or  other  grave  accidents  entirely  unnecessary  of  induc- 
tion under  all  ordinary  circumstances.  Such  lesions  as  do 
occur  pre'sent  no  pathological  features  not  present  in  the  com- 
mon blister  except  that  they  are  usually  considerably  deeper; 
ordinary  surgical  treatment  is  all  that  it  is  necessary  to  apply 
for  their  cure. 

Centra-Indications. 

This  phase  of  our  subject  will  have  to  be  investigated  fur- 
ther, clinically,  before  much  can  be  said  of  it.  As  we  have 
seen,  the  influence  of  this  agent  under  judicious  administra- 
tion consists  of  a  pure  and  simple  stimulation  of  normal  physio- 
logical processes  without  pernicious  reactive  manifestations, 
which  therefore  results  merely  in  accentuation  of  normal  me- 
tabolism and  of  the  natural  constitutional  resistance  against 
agencies  or  conditions  which  threaten  the  well-being  of  the 
organism.  Theoretically,  then,  it  would  seem  that  it  ought, 
upon  general  principles,  to  be  useful  in  almost  any  pathological 
condition  characterized  by  impairment  of  physiological  func- 
tion ;  practically,  in  our  own  experience,  the  inference  has  ap- 
peared to  be  very  well  justified,  almost  no  centra-indications 
that  would  stand  the  test  of  clinical  investigation  having  been 
ascertained. 

Malignant  disease  would  seem  to  offer  an  unfavorable  field 
for  exercise  of  the '  activities  of  the  local  application  because 
of  the  effect  of  such  activities  in  stimulating  cell  growth;  I 
know  of  no  clinical  data  that  furnish  reliable  information  upon 
this  point,  however. 

A  recent  cerebral  hemorrhage  would  seem  to  constitute  a 
condition  in  which  it  would  not  be  best  to  invoke  the  char- 
acteristic influences  of  the  general  application ;  here  again,  how- 
ever, I  know  of  no  instance  wherein  the  hypothesis  has  been 
put  to  the  test  of  trial. 


88  Therapeutics  of  Dry  Hot  Air. 

Atheroma  and  Irregular  Pulse. — The  belief  entertained  by 
many  that  patients  with  atheromatous  arteries  or  irregular 
pulse  should  not  be  subjected  to  the  body  treatment,  is  a 
fallacy. 

Clinical  observation  justifies  the  statement  that  atheromatous 
arteries  are  softened  and  rendered  more  functionable  by  the 
use  of  this  measure,  through  absorption  of  lime  salts  deposited 
in  their  walls  and,  at  least  partial,  regeneration  of  normal  con- 
nective tissue  elements ;  we  have  repeatedly  treated  individ- 
uals who  have  had  previously  one  and  two  cerebral  hemor- 
rhages with  none  but  beneficial  results. 

In  treating  patients  exhibiting  atheromatous  phenomena  it 
is  well  to  run  the  heat  up  slowly  during  the  first  three  or  foui 
seances,  watching  the  effects  carefully  meanwhile  and  sus- 
pending further  increase  in  treatment  intensity  when  the  heart 
and  carotids  begin  to  labor  unduly ;  but  we  have  never  encoun- 
tered the  slightest  cause  for  anxiety  with  them  any  more  than 
with  others  when  carefully  handled. 

Irregularity  of  the  pulse  coming  on  during  the  treatment 
of  such  a  patient  should  always  be  a  signal  for  the  exercise 
of  watchfulness  and  usually  for  the  termination  of  the  appli- 
cation. 

Valvular  Heart  Lesions. — The  modifications  of  the  circu- 
latory phenomena  attributable  to  the  general  dry  hot  air  appli- 
cation are  so  similar  to  those  brought  about  by  the  administra- 
tion of  nitro-glycerine,  sparteine,  strychnia,  etc.,  that  the 
position  involving  objection  to  its  employment  with  patients 
exhibiting  valvular  heart  lesions  becomes  obviously  untenable ; 
this  subject  may  therefore  be  dismissed  without  further  con- 
sideration. 

Pyrexia. — A  glance  at  the  list  of  diseases  in  the  treatment 
of  which  this  agent  renders  valuable  service  demonstrates  that 
elevation  of  the  body  temperature  interposes  no  valid  objection 
to  its  administration.  Fever,  per  se,  is  merely  a  secondary 
result  of  a  primary  pathological  factor ;  its  degree  is  dependent 
upon  the  intensity  of  the  causative  process  and  the  degree  of 
reactionary  susceptibility  exhibited  by  the  individual  patient, 
hence  its  treatment  should  be  that  of  the  condition  producing  it. 


Technique.  89 

The  phenomenon  of  pyrexia  is  believed  by  some  observers 
to  be  directly  dependent  upon  irritation  of  the  sympathetic 
nerve  centers  by  toxic  bodies  elaborated  by  the  active  primary 
pathological  factors;  by  others  as  due  to  impairment  of  the 
heat  inhibitory  centers  traceable  to  the  same  cause;  and  by 
still  others  it  is  believed  to  constitute  an  expression  of  nature's 
effort  to  rid  herself  of  disability  by  accentuation  of  the  normal 
metabolic  (oxidative)  processes,  the  increase  in  heat  produc- 
tion being  the  logical  physical  result  of  accelerated  chemical 
reactions,  and  energy  transformation  as  represented  by  aug- 
mented reflex  functionation  of  nervous  structures. 

If  the  last-mentioned  explanation  should  ultimately  prove  to 
be  the  true  one,  and  there  is  good  reason  for  such  belief,  it 
is  obvious  that  the  remedial  agent  under  discussion  will  be 
the  most  useful  as  well  as  the  most  logical  means  of  combating 
secondary  febrile  phenomena  now  known;  it  is  a  pure  and 
simple  but  powerful  accelerant  of  normal  physiological  pro- 
cesses and  being  such  merely  assists  in  and  augments  the  in- 
stinctive natural  effort  of  the  organism  to  regain  its  molecular, 
structural,  and  functional  integrity. 

Whatever  explanation  is  accepted  the  palpable  therapeutic 
indications  suggested  by  modern  conceptions  of  the  direct 
etiology  of  fever,  consist  of  measures  tending  to  increase  elim- 
ination of  toxaemia  and  the  functional  vigor  of  the  disturbed 
nerve  centers;  the  general  dry  hot  air  application  is  extremely 
well  calculated  to  accomplish  both  of  these  objects. 

Another  fact  that  may  be  significant  in  this  connection,  is 
that  patients  exhibiting  febrile  movement  usually  express  them- 
selves as  being  comforted  and  tranquilized  by  a  dry  hot  air 
application ;  they  welcome  instead  of  resisting  it. 

At  first  thought  it  would  be  supposed  that  such  an  application 
would  be  intolerable  to  a  patient  who  is  already  suffering  from 
excessive  elevation  of  temperature,  but  the  actual  result  of 
the  application  tends  to  confirm  the  reasoning  set  forth  in  a 
preceding  section  as  to  the  relative  effects  of  heat  and  cold 
as  regards  the  harmony  or  antagonism  which  they  respectively 
exhibit,  with  reference  to  the  natural  efforts  by  which  the 
organism  endeavors  to  rid  itself  of  disability.  Future  investi- 


90  Therapeutics  of  Dry  Hot  Air. 

gation  appears  to  promise  interesting  developments  along  the 
lines  herein  suggested. 

Hyper-Pyrexia. — In  this  peculiar  and  interesting  condition, 
wherein  the  general  bodily  metabolism  seems  to  run  amuck,  dry 
hot  air  has  not  yet  been  tried  as  far  as  I  know.  The  condi- 
tion is  supposed  to  be  caused  by  exhaustion  of  the  heat  inhibi- 
tory centers  brought  about  by  an  intolerable  degree  of  irrita- 
tion exercised  upon  them  by  toxic  bodies  in  the  blood. 

The  only  remedy  that  has  hitherto  proven  itself  of  much  use 
has  been  the  application  of  cold  to  the  general  surface  of  the 
body,  which  has  been  supposed  to  act  by  reflex  stimulation  of 
the  exhausted  nerve  centers  and  by  checking  the  excessive 
metabolic  activity  through  the  abstraction  of  heat. 

As  we  have  seen,  when  considering  the  physiological  action 
of  dry  hot  air,  there  is  a  vital  difference  between  the  effects  of 
hot  and  cold  applications  and  as  a  rule  this  difference  favors 
the  employment  of  heat  rather  than  cold.  Whether  or  not  this 
is  the  case  as  regards  hyper-pyrexia  is  a  matter  for  future  in- 
vestigation to  decide.  As  was  also  explained  in  the  previous 
chapter  .dry  hot  air  applications  of  appropriate  intensity  accom- 
plish their  stimulation  without  imposing  any  initial  strain  upon 
the  vital  powers ;  in  the  condition  under  consideration  these 
powers  are  already  strained  beyond  their  limit  of  endurance 
and  if  the  reinvigoration  could  be  secured  without  the  pro- 
duction of  additional  antagonistic  tension  it  would  seem  to  be 
desirable  to  so  secure  it. 

Present  knowledge  and  logic,  therefore,  would  seem  to  in- 
dicate that  investigation  of  the  effects  of  dry  hot  air  in  hyper- 
pyrexia  would  be  justifiable  as  well  as  interesting. 

Local  Infective  or  Inflammatory  Foci. — It  is  sometimes 
stated  that  dry  hot  air  applications  to  localized  inflammatory 
processes  of  any  sort  are  dangerous  and  likely  to  transform  the 
local  into  a  general  pathological  condition.  I  have  never 
heard  a  logical  defense  of  this  position,  I  have  never  heard 
of  an  authentic  case  wherein  there  was  any  satisfactory  evi- 
dence that  such  a  result  was  properly  attributable  to  dry  hot 
air,  and  in  the  hundreds  of  such  treatments  that  I  have  adminis- 
tered myself  and  have  had  administered  under  my  supervision 


Technique.  91 

to  such  cases,  I  have  never  in  a  single  instance,  seen  the  slight- 
est reason  for  believing  that  dry  hot  air  was  guilty  or  capable 
of  precipitating  such  a  disaster;  I  am  therefore  free  to  state 
my  entire  disbelief  in  the  existence  of  any  cause  for  apprehen- 
sion in  this  respect. 

Until  experience  has  widened,  however,  it  will  be  wise  to 
exercise  a  judicious  conservatism  when  invading  pathological 
fields  wherein  the  actual  effects  of  this  very  potent  agency 
have  not  yet  been  investigated,  the  capacity  of  a  measure  for 
the  production  of  good  being  sometimes  only  equaled  by  its  evil 
tendencies  when  applied  to  improperly  selected  conditions. 

We  will  now  consider  the  practical  application  of  dry  hot  air 
to  those  diseases  in  the  treatment  of  which  it  has  been  demon- 
strated to  be  of  value,  and  the  order  in  which  these  diseases  are 
considered  will  be  found  to  coincide  approximately  with  the 
degree  of  importance  which  the  agent  assumes  in  their  man- 
agement. 


CHAPTER   IV. 
SPRAINS. 

Modifications  of  Clinical  Conditions 
producible  unth  Dry  Hot  Air. 

Local  Application. 

First,  immediate  relief  of  pain,  which  relief  can  be  rendered 
practically  permanent  by  repeating  the  treatment  as  often 
as  the  pain  becomes  troublesome. 

Second,  rapid  removal  of  exudate. 

Third,  a  rapidity  of  repair  which  exceeds  that  attainable 
with  any  other  agent  noiv  known,  and  by  reason  of  ivhich,  gen- 
eral systemic  impairment  due  to  pain  or  lack  of  exercise  from 
confinement  to  the  bed,  chair,  or  house  never  supervenes. 

Gener.al  Application. 

Hastening  of  the  reparatire  process  in  all  cases,  and  rapid 
removal  of  general  debility  in  old  cases. 

RATIONALE    OF    THERMOTHERAPY. 

Pathology  and  Symptomatology. — A  sprain  consists  sim- 
ply, in  uncomplicated  cases,  of  traumatic  solution  of  the  con- 
tinuity of  soft  issues  about  the  affected  joint,  accompanied  by 
severe  pain  and  more  or  less  impairment  of  function ;  a  strictly 
local  condition  which  is  not  inherently  capable  of  precipitating 
secondary  phenomena  which  threaten  the  integrity  of  the 
organism  at  large. 

Therapeutic  Indications. — First,  to  relieve  the  pain. 

Second,  to  so  influence  the  trophic  functions  of  the  affected 
part  as  to  secure  the  quickest  possible  repair. 

Third,  to  secure  absorption  of  the  exudate. 

Local  Application. — Theoretically  the  physiological  influ- 
ence of  the  local  dry  hot  air  treatment  should  be  most  ex- 

92 


Sprains.  93 

quisitely  applicable  here  ;  practically,  clinical  experience  demon- 
strated the  validity  of  the  deduction.  As  a  matter  of  fact  if  a 
sprain  is  gotten  under  treatment  by  this  agent  within  four  or 
five  hours  after  the  injury  has  been  sustained,  the  pain  will 
be  relieved  within  half  an  hour  and  all  traces  of  the  trouble 
will  frequently  have  disappeared  within  forty-eight  hours.  If 
the  case  has  been  running  on  for  two  or  three  days,  on  the  other 
hand,  and  exudate  is  present  to  any  great  extent  complete 
removal  of  disability  will  require  from  one  to  three  weeks ;  the 
pain,  however,  is  susceptible  of  the  same  immediate  relief  as  in 
the  early  cases. 

Although  such  results  may  appear  magical  at  first  thought, 
yet  when  the  subject  is  considered  from  an  analytical  stand- 
point it  is  recognized  that  the  agent  produces  its  results  in  the 
same  way  as  does  every  other  successful  treatment  of  the  con- 
dition, viz.,  through  its  action  upon  the  circulatory  and  trophic 
functions.  The  greater  rapidity  of  repair  obtained  and  the 
more  effectual  relief  of  pain,  are  due  merely  to  the  greater 
profundity  of  its  physiological  action,  and  its  general  influence 
in  these  directions  is  beautifully  exemplified  by  its  effects  in 
this  condition. 

It  is  only  necessary  to  compare  the  course  of  events  marking 
recovery  from  a  sprain  under  ordinary  management,  which  not 
infrequently  extends  over  a  period  of  six  or  eight  weeks,  with 
those  just  outlined  in  order  that  the  immense  advantages  exhib- 
ited by  dry  hot  air  in  the  treatment  of  the  condition  may  be 
appreciated. 

If  a  sprain  is  complicated  by  bony  fracture  the  local  appli- 
cation will  usually  relieve  the  pain  somewhat ;  less  frequently 
it  will  not  relieve  it  at  all ;  and  sometimes  it  makes  it  worse.  If 
the  treatment  fails  to  produce  practically  complete  relief  of  pain 
it  is  almost  positive  evidence  that  such  fracture  coexists. 

General  Application. — A  sprain  is  usually  sustained  while 
the  victim  is  in  good  health,  and  as  the  lesion  manifests  no 
inherent  tendencies  toward  impairment  of  the  general  metabolic 
functions  the  body  treatment  is  rarely  called  for  in  recent  cases. 
In  those  of  some  standing,  however,  wherein  the  central  ner- 
vous system  is  feeling  the  evil  influence  of  long-continued  pain 


94  Therapeutics  of  Dry  Hot  A  ir. 

and  loss  of  sleep,  in  patients  exhibiting  a  low  grade  of  vitality, 
or  when  repair  has  become  sluggish  from  any  cause  the  general 
application  is  of  the  greatest  assistance. 

ILLUSTRATIVE    CASE. 

Mrs.  R.  H.,  aged  sixty-three  years.  Patient  had  slipped  on  a 
curbstone  during  the  afternoon  of  May  26,  1900,  spraining  her 
left  ankle.  I  was  asked  to  see  her  in  the  evening,  at  which 
time  severe  throbbing  pain  was  constantly  present,  a  swelling 
about  the  size  of  a  butternut  was  evident  just  below  and  an- 
terior to  the  external  malleolus,  and  the  tissues  in  this  region 
were  so  sensitive  as  to  be  entirely  intolerant  of  any  but  the 
gentlest  of  manipulation.  She  was  unable  to  put  her  foot  to  the 
floor  because  of  the  resultant  excruciating  exacerbation  of 
the  pain. 

A  local  dry  hot  air  treatment  was  administered  at  450°  F. 
for  an  hour,  which  entirely  relieved  the  pain,  and  she  was  put 
to  bed  without  any  bandage  or  other  local  application  to  the 
foot. 

May  27th,  1 1  A.  M.  Patient  had  been  free  from  pain  during 
the  night  and  had  slept  well.  The  swelling  had  diminished  a 
good  fifty  per  cent.,  and  only  deep  pressure  upon  the  injured 
tissues  elicited  protest.  Stepping  upon  the  affected  member 
caused  her  slight  pain  and  holding  it  suspended  downward 
provoked  a  dull,  throbbing  ache. 

Another  local  dry  hot  air  treatment  was  administered  at 
485°  F.  for  an  hour,  an  elastic  bandage  applied  about  the 
ankle  in  such  a  way  as  to  give  support  to  the  lacerated  struc- 
tures and  the  patient  allowed  to  be  up  and  about  at  her  pleasure. 

May  27th,  10  P.  M.  Ankle  had  been  entirely  comfortable 
all  day.  Swelling  had  entirely  disappeared,  but  some  tender- 
ness upon  deep  pressure  was  still  observable  immediately  below 
and  anterior  to  the  outer  malleolus. 

The  third  and  last  dry  hot  air  application  was  administered 
and  directions  given  to  apply  the  elastic  bandage  again  next 
morning  before  she  left  her  bed. 

I  saw  her  again  during  the  morning  of  May  29th,  or  sixty 
hours  after  the  first  dry  hot  air  treatment  had  been  given,  and 
all  signs  of  the  injury  had  disappeared ;  the  elastic  bandage  was 
discarded  and  the  incident  closed. 

TREATMENT. 

Local  Dry  Hot  Air  Application.— A  sprained  joint  rapidly 
becomes  extremely  sensitive  to  manipulation  and  when  one 


Sprains.  95 

comes  under  treatment,  however  early,  the  slightest  movement 
will  usually  cause  excruciating  pain.  The  wrappings  should 
therefore  be  applied  with  the  utmost  gentleness  and  when 
pressing  them  against  parts  that  complain  during  administra- 
tion this  exquisite  sensitiveness  should  be  borne  in  mind. 

The  application  should  be  continued  for  an  hour  and  the 
degree  of  heat  employed  should  not  be  less  than  350°  F. ;  in 
some  cases  it  will  need  to  be  pushed  to  450°  F.  If  the  joint  is 
superficial,  the  patient  not  obese,  and  little  oedema  present  350° 
F.  will  usually  be  sufficient;  if  the  impaired  structures  are 
covered  by  large  muscles  or  a  thick  layer  of  adipose  or 
cedematous  tissue,  on  the  other  hand,  from  400°  to  450°  F. 
will  be  required. 

After  the  seance,  if  the  patient  desires  to  move  about  the 
joint  should  be  enwrapped  by  an  elastic  stockinet  bandage, 
so  applied  as  to  support  the  ligaments  tension  upon  which 
causes  pain.  When  sitting  or  lying  down  no  bandage  is 
necessary  but  the  joint  should  be  kept  elevated;  observance  of 
this  latter  point  will  frequently  prevent  the  pain  from  becom- 
ing troublesome  after  the  first  treatment. 

In  old  cases  relief  of  pain  is  just  as  prompt  but  repair  is 
slower  in  proportion  as  exudation  and  secondary  changes  in 
the  tissues  are  extensive. 

The  local  application  should  be  made  twice  daily  anyway 
and  oftener  if  return  of  pain  demands  it. 

General  Dry  Hot  Air  Application. — The  technique  is  that 
usual  to  this  procedure ;  it  may  be  applied  every  other  day  until 
three  applications  have  been  given  and  every  third  day  there- 
after if  its  continued  use  should  be  necessary. 

Additional  Remedial  Measures. 

When  dry  hot  air  is  applied  early  any  other  measure  will 
very  rarely  indeed  require  consideration  at  all,  but  in  older 
cases  other  agents  are  useful  in  combination  with  it. 

Mechanical  vibratory  stimulation,  the  electrical  currents, 
massage,  and  alternating  hot  and  cold  douche,  applied  daily 
in  alternation  with  the  thermal  agent,  one  in  the  morning, 
another  at  noon  and  another  at  night,  are  efficient  in  the  order 


96  Therapeutics  0f  Dry  Hot  Air. 

in  which  they  are  named;  the  two  first-mentioned  when  used 
alone  sometimes  will  produce  results  that  rival  those  obtain- 
able with  dry  hot  air. 

Liniments  are  uncalled  for,  and  useless  except  as  lubricants, 
when  dry  hot  air  is  available. 


CHAPTER  V. 
RHEUMATISM. 

Modifications  of  Clinical  Conditions 
producible  with  Dry  Hot  Air. 

Local  Application. 

First,  immediate  relief  of  the  pain  however  severe,  which 
relief  may  be  rendered  practically  continuous  by  repeating  the 
treatments  as  often  as  the  pain  becomes  troublesome,  every 
four  hours  if  necessary. 

Second,  shortening  of  the  duration  of  the  disease,  the  same 
usually  lasting  only  from  five  to  ten  days  when  dry  hot  air  is 
thoroughly  administered  in  combination  with  well  chosen  drugs. 

Third,  lessening  of  the  likelihood  of  cardiac  involvement,  be- 
cause the  rapid  control  obtained  over  the  condition  diminishes 
the  time  period  during  which  the  infection  threatens  struc- 
tures other  than  those  originally  involved. 

Fourth,  lessening  of  the  number  and  quantity  of  medicines 
which  it  is  necessary  for  the  patient  to  ingest,  because  of  the 
increase  produced  in  the  intensity  and  efficiency  of  their  action 
at  the  seat  of  infection. 

General  Application. 

Lessening  of  general  systemic  toxcemia  and  intensification 
of  the  physiological  resistance  of  the  organism  as  a  whole. 

RATIONALE    OF    THERMOTHERAPY. 

Etiology,  Pathology,  and  Symptomatology. — In  the  early 
seventies  of  the  century  just  closed  McLagon  of  London,  Eng- 
land, published  his  belief  that  rheumatism  was  a  disease  caused 
by  a  specific  "  Materies  morbi  "  circulating  in  the  blood,  and 
that  salicylic  acid  as  a  specific  curative  agent  sustained  much 
the  same  relation  to  it  that  quinine  was  believed  to  sustain 

97 


98  Therapeutics  of  Dry  Hot  Air. 

to  malaria;  that  as  a  disease  it  was  in  many  ways  and  to  a 
considerable  degree  analogous  to  malaria.  Although  the  an- 
nouncement was  met  by  the  same  overwhelming  skepticism 
and  derision  that  has  so  strangely  been  heaped  upon  nearly 
every  great  discovery  in  the  medical  world  since  the  dawn  of 
history,  yet  the  conviction  of  its  truth,  at  least  as  far  as  the 
etiological  element  is  concerned,  has  steadily  gained  ground 
until  the  profession  to-day  is  almost  ready  to  look  upon  the 
infectious  origin  of  the  ailment  as  an  established  fact. 

Discussion  of  the  etiological  ramifications  per  se  does  not 
come  within  the  scope  of  this  work,  and  those  who  desire  to 
pursue  the  matter  further  will  find  a  masterly  and  convincing 
exposition  of  this  view  of  the  subject  in  the  second  volume  of 
the  "  Twentieth  Century  Practice  of  Medicine,"  in  the  section 
devoted  to  this  somewhat  remarkable  and  most  interesting 
disease.  We  are  somewhat  concerned,  however,  as  will  be 
seen  later,  with  the  latter  part  of  the  McLagon  contention, 
viz. :  that  salicylic  acid  is  as  much  of  a  "  specific  "  in  the  treat- 
ment of  rheumatism  as  is  quinine  in  that  of  malaria. 

The  pathology  present  consists  of  fluid  effusion  into  the  sub- 
cutaneous tissues  overlying  the  affected  joint,  the  soft  tissues 
immediately  about  the  joint,  and  to  a  limited  extent  into  the 
joint  cavity;  and  an  inflammatory  process  involving  these 
structures  which  is  intense  in  its  nature  and  exhibits  the  weli- 
known  characteristic  that,  no  matter  what  the  degree  of  sever- 
ity, it  never  eventuates  in  suppuration.  After  an  attack  of 
true,  uncomplicated  rheumatism  has  subsided  the  affected  joint 
structures  spontaneously  and  completely  resume  their  normal 
condition. 

Fibrous  adhesions  have  commonly  been  looked  upon  as 
forming  a  prominent  element  in  the  pathology  of  "  chronic  " 
rheumatism,  but  modern  clinical 'observation  and  knowledge 
indicate  that  this  condition  is  rarely,  if  ever,  met  with  as  a  post- 
rheumatic  lesion  and  that  when  it  is  so  alleged  the  diagnosis 
of  the  original  trouble  should  be  subjected  to  close  scrutiny. 

The  joint  pathology  is  accompanied  by  excruciating  pain  in 
the  affected  part,  which  is  increased  by  motion  and  manipula- 
tion and  probably  due  to  pressure  upon  the  nervous  structures, 


Rheumatism.  99 

the  presence  of  which,  in  turn,  could  easily  be  traceable  to  cir- 
culatory stasis  in  the  part ;  and  a  condition  of  general  systemic 
toxaemia  evidenced  by  a  moderate  degree  of  febrile  movement 
which  is  entirely  irregular  in  its  course,  general  malaise,  and  a 
profuse  sour  perspiration. 

An  undetermined  etiology  and  a  pathology  so  lacking  in 
significant  features,  as  far  as  indicating  what  direction  treat- 
ment should  assume  is  concerned,  furnish  us  very  unsatisfac- 
tory grounds  upon  which  to  build  a  rational  therapy ;  we  have 
therefore  to  depend  principally  upon  the  symptomatology  and 
empirical  knowledge  for  the  evolution  of  a  plan  of  manage- 
ment, and  a  study  of  the  symptomatology  would  suggest  direct- 
ing our  efforts  toward  the  attainment  of  the  following  objects : 

Therapeutic  Indications. — First,  relief  of  the  pain,  which 
symptom  is  probably  due  to  circulatory  stasis. 

Second,  removal  of  the  local  inflammatory  conditions  and 
restoration  of  joint  function. 

Third,  reduction  of  the  general  systemic  toxaemia. 

Local  Application. — The  palliative  influence  of  hot  applica- 
tions upon  the  pain  of  rheumatic  inflammation  has  long  been  a 
matter  of  common  knowledge  and  it  was  this  fact  that  first  led 
me  to  employ  dry  hot  air  in  treating  this  affection;  if  mild 
degrees  of  heat  would  give  some  relief  greater  intensities  might 
be  productive  of  much  benefit.  The  results  which  followed  its 
use  so  far  exceeded  my  expectations  as  to  border  upon  the  mar- 
velous. Patients  who  were  suffering  indescribable  torment 
were  transported  to  a  condition  of  ease  and  comfort  in  half  an 
hour  and  would  sometimes  have  recovered  entirely  in  a  few 
days ;  mechanics  who  had  been  unable  to  work  for  months  and 
in  whom  the  general  condition  had  been  much  impaired  by  the 
disease  were  restored  to  health  and  enabled  to  resume  their 
occupations  in  two  weeks. 

To  one  who  is  not  in  the  habit  of  treating  rheumatism  with 
this  agent  the  effects  obtainable  are  absolutely  beyond  belief 
unless  personally  witnessed.  Professor  Wood  of  Philadelphia 
voiced  a  sentiment  common  to  thermotherapists  when  he  made 
the  remark  that  the  results  of  dry  hot  air  applications  to  some 
joint  conditions  were  "  almost  miraculous." 


ioo  Therapeutics  of  Dry  Hot  Air. 

At  the  time  of  my  original  observations  along  this  line  I  had 
not  expended  much  thought  upon  the  physiological  action  of 
the  agent,  but  when  we  study  this  in  connection  with  the  caus- 
ation of  rheumatic  pain  we  are  no  longer  surprised  at  its  effi- 
ciency in  relieving  the  same;  it  is  simply  a  manifestation  of 
the  powerful  influence  of  the  local  dry  hot  air  application  in 
overcoming  local  circulatory  stasis  whereby  pressure  upon 
nervous  structures  is  relieved.  How  much,  or  whether  much 
of  the  effect  is  due  to  stimulation  of  local  oxidation  processes 
through  the  raising  of  the  temperature  of  the  part  en  masse,  or 
to  local  elimination  of  toxins  cannot  at  present  be  definitely 
stated;  removal  of  circulatory  stasis,  however,  would  seem 
to  be  sufficient  to  account  for  the  result  without  having  to 
assume  that  any  other  factor  is  active. 

That  the  influence  upon  the  local  conditions  other  than  stasis 
is,  however,  profound  is  evidenced  by  the  facts  that  great 
immediate  improvement  in  the  general  condition,  which  goes 
on  to  rapid  recovery,  usually  follows  the  administration  of  local 
dry  hot  air  applications  if  an  appropriate  salicyl  compound  is 
given  in  efficient  dosage  along  with  the  thermal  agent;  that 
such  improvement  is  much  greater  and  recovery  much  quicker 
than  when  the  salicyl  is  administered  without  the  dry  hot  air; 
and  that  a  convalescence  that  is  dragging  along  unsatisfactorily 
under  salicyl  treatment  alone  will  be  accelerated  and  rapidly 
eventuate  in  full  recovery  when  the  thermal  element  is  added 
to  the  therapeutical  regimen.  The  relief  of  local  stasis  and 
pain  is  not  sufficient  to  account  for  these  phenomena;  they 
are  explicable  only  upon  the  assumption  that  influence  has 
been  exerted,  either  directly  or  indirectly,  upon  one  or  more 
of  the  primary  causative  factors.  What  these  factors  are  or  in 
what  way  they  respond  to  this  influence  cannot  be  stated  until 
the  etiology  of  the  disease  has  been  conclusively  ascertained. 

Conversely  to  the  foregoing  it  may  be  as  well  to  state  here, 
as  elsewhere,  that  dry  hot  air  applications  without  salicylic  acid 
do  not  constitute  a  satisfactory  management  for  rheumatism 
in  any  large  number  of  consecutive  cases.  It  will  almost 
always  relieve  the  pain  temporarily,  but  it  cannot  be  depended 
upon  to  cure  the  disease. 


Rheumatism.  101 

The  preceding  paragraph  would  suggest  the  query  "  Why 
will  not  dry  hot  air  alone  cure  rheumatism?  If,  as  is  all  but 
proven,  this  ailment  is  of  microbic  etiology  it  resembles,  to 
some  extent,  local  septic  infection,  and  it  would  naturally  be 
expected  that  the  agent  ought  to  exercise  much  the  same 
power  over  rheumatism  that  it  does  (as  we  shall  see  in  the 
following  chapter)  over  septic  infection  ?  " 

We  can  only  answer  that  the  infective  agent  of  rheumatism 
differs  from  other  pathogenic  germs.  We  have  already  noted 
one  great  and  important  peculiarity,  viz. :  that  the  inflammatory 
process  of  which  it  is  provocative  never  eventuates  in  suppu- 
ration ;  if  it  differs  in  one  particular  it  may  safely  be  assumed  to 
be  capable  of  differing  in  others,  and  the  extent  and  number  of 
its  variations  cannot  be  estimated  until  it  has  been  isolated  and 
studied. 

Whatever  the  future  may  divulge  as  to  these  points  the  fact 
which  concerns  us  in  this  connection  remains,  viz.,  that  the 
simultaneous  administration  of  salicyl  compounds  is  necessary 
to-day,  in  order  that  dry  hot  air  may  produce  its  most  effective 
influence  upon  true  rheumatic  inflammation,  and  it  will  be 
helpful  to  consider  briefly  at  this  point  the  relation  sustained 
by  this  drug  to  the  problem  under  discussion. 

Is  Salicylic  Acid  a  "  Specific  "  for  Rheumatism? — The 
claim  that  this  substance  is  as  much  of  a  specific  in  the  treat- 
ment of  rheumatism  as  is  quinine  in  that  of  malaria,  is  as 
bitterly  opposed  to-day  by  many  as  was  the  claim  for  an  infec- 
tious causation  of  the  former  disease  thirty  years  ago.  In 
order  to  decide  this  point  definitely  it  would  first  be  necessary 
to  understand  the  modus  operandi  by  which  the  well-known 
influences  of  quinine  upon  malaria  and  of  salicylic  acid  upon 
rheumatism  are  brought  about. 

It  was  formerly  supposed  that  the  curative  effect  of  quinine 
upon  malaria  was  due  to  a  toxic  influence  exerted  by  this  sub- 
stance upon  the  plasmodium,  either  directly  or  by  modification 
of  its  pabulum ;  the  advocates  of  the  McLagon  contention  con- 
sidered it  probable  that  salicylic  acid  acted  in  an  analogous 
manner  upon  the  specific  mat  cries  morbi  of  rheumatism. 
Recent  radiological  studies  by  King,  Busc,  Halberstaedter, 


L, 

£  1C  I  A.K  v_  L.L 

LC  £    ixUHL  LUE^.ii.  kfc 


IO2  Therapeutics  of  Dry  Hot  Air. 

Dreyer,  and  others,  have,  however,  given  rise  to  the  concep- 
tion that  the  curative  power  of  quinine  may  be  due  to  its  prop- 
erty of  modifying  the  fluorescence  of  the  blood  rather  than  to 
direct  toxic  action  exerted  upon  the  specific  infective  agent; 
salicylic  acid  is  also  a  fluorescible  substance,  and  the  McLagon 
chain  of  analogy  between  malaria  and  rheumatism  which  first 
led  its  author  to  administer  salicin  for  the  cure  of  the  last-men- 
tioned disease  may  thus,  perhaps,  be  ultimately  furnished  with 
another  link. 

As  the  facts  stand  at  present  we  cannot  arrive  at  a  positive 
solution  of  the  problem,  but  the  future  seems  pregnant  with 
interesting  developments  along  these  lines.  We  are  living  in  an 
age  of  rapid  progress ;  an  age  that  has  been  characterized  by 
the  demolition  of  theories  that  for  years  had  been  looked  upon 
as  impregnably  intrenched  behind  the  rampart  of  truth,  and  he 
is  a  bold  man  who  to-day  will  say  to  the  enterprising  theorist, 
as  Canute  said  to  the  sea,  "  Thus  far  shalt  thou  go  and  no 
farther."  As  far  as  the  present  discussion  is  concerned,  how- 
ever, the  most  important  fact  upon  which  the  claim  for  specific- 
ness  of  the  salicyl  compounds  has  been  assailed  is,  that  they 
fail  to  cure  in  many  cases,  and  some  significant  information 
bearing  upon  this  point  may  be  gathered  by  noting  some  of  the 
clinical  aspects  of  these  diseases  as  regards  response  to  their 
alleged  specific  remedies. 

The  belief  that  quinine  bears  such  a  relation  to  malaria  was 
engendered  by  the  repeated  observations  of  a  large  number  of 
physicians,  which  demonstrated  that  the  disease  almost  invari- 
ably responded  happily  to  administration  of  the  drug  in  ade- 
quate dosage ;  many  clinicians  indeed  hold  that  if  a  given  case 
does  not  so  respond  the  diagnosis  of  malaria  must  be  changed, 
however  well  justified  in  the  first  place. 

Now  although  this  belief  is  so  thoroughly  established  in  the 
medical  mind  to-day,  and  it  has  stood  the  test  of  practical 
experience  .  for  many  years,  yet  occasionally  a  victim  of 
malaria  is  encountered  who  is  taking  quinine  to  the  point  of 
intoxication  and  shaking  at  each  regular  interval  in  spite  of  it. 
This  does  not  invalidate  the  claims  of  the  drug  to  specificness 
in  our  minds,  however,  because  we  know  that  the  cause  of  its 


Rheumatism.  103 

failure  is  inefficiency  of  assimilation  or  metabolism  somewhere 
in  the  economy,  and  that  when  this  has  been  corrected  the  drug 
will  manifest  its  customary  influence ;  the  difficulty  is  not  that 
the  remedy  has  proven  itself  inherently  incapable,  but  that  it 
has  been  called  upon  to  exhibit  its  powers  under  overwhelming 
inhibitive  conditions.  If  the  interfering  factor  is  the  liver,  a 
chologogue  is  administered ;  if  general  debility,  strychnia  and 
iron,  or  arsenic ;  then  quinine,  and  the  malaria  disappears. 

Another  prominent  factor  tending  toward  maintenance  of 
the  reputation  of  quinine  as  a  specific  for  malaria  is  the  fact 
that  remedies  which  have  long  been  known  and  commonly 
used  as  tonics  constitute  efficient  auxiliary  agents  for  the 
removal  of  conditions  which  interfere  with  the  exercise  of  its 
characteristic  influence.  Still  another  fact  that  has  been  favor- 
able to  quinine  in  this  connection  is  that  many  trivial  condi- 
tions which  would  respond  to  mild  tonic  and  chologogue  reme- 
dies have  in  the  past  been  erroneously  diagnosticated  as 
"  Malaria,"  hence  the  drug  has  absorbed  considerably  more 
credit  than  rightfully  belonged  to  it. 

As  regards  salicylic  acid,  the  conditions  have  been  very 
different.  In  the  first  place  comparatively  few  practitioners 
have  given  the  drug  in  sufficiently  large  quantities ;  one  or  two 
grams  of  sodium  salicylate  per  day  having  been  called  upon  to 
cure  when  two  or  three  times  that  quantity  should  have  been 
given,  and  inefficiency  has,  of  course,  resulted. 

Second,  many  stomachs,  hearts,  and  kidneys  cannot  tolerate 
sodium  salicylate  in  sufficient  dosage  to  effect  the  desired 
result,  and  although  the  substitution  of  salicin  will  usually 
overcome  this  difficulty,  it  requires  to  be  given  in  twice  as  large 
a  quantity  (4  to  8  grams  per  day)  as  sodium  salicylate  in 
order  that  the  same  degree  of  salicyl  influence  may  be  secured, 
and  the  disadvantage  contingent  upon  this  greater  bulk  has 
generally  resulted  in  the  more  irritant  substance  being  em- 
ployed. 

Third,  although  the  undeniable  inefficiency  of  salicylic  acid 
in  some  of  those  cases  wherein  adequate  dosage  was  practicable 
and  practiced  would  naturally  first  suggest,  to  follow  out  the 
malarial  analogy,  that  impairment  of  assimilation  and  metab- 


IO4  Therapeutics  of  Dry  Hot  Air. 

olism,  local  or  general,  was  the  element  of  interference,  yet 
the  drugs  ordinarily  used  to  remove  such  impairment  have  not 
proven  nearly  as  uniformly  successful  as  auxiliaries  to  the 
salicyl  compounds  in  the  attack  upon  rheumatism,  as  to  quinine 
in  that  upon  malaria;  the  logical  inference  being  that  the 
incapacity  of  salicylic  acid  so  manifested  was  inherent  in 
itself. 

Fourth,  many  conditions  exhibiting  painful  joints,  nerves, 
or  muscles  as  symptomatic  phenomena,  have  in  the  past  been 
diagnosticated  as  rheumatism  which  were  not  rheumatism  at 
all,  and  no  matter  how  specific  the  drug  might  be  against  rheu- 
matism it  would  not  of  course  be  expected  to  acquire  any  last- 
ing laurels  under  such  circumstances. 

Lastly,  there  are  very  few  other  painful  conditions  that 
would  be  likely  to  be  confounded  with  rheumatism  and  which 
would  respond  happily  to  anti-rheumatic  treatment,  hence  the 
drug  would  not  be  accredited  with  curative  results  for  which 
it  was  not  responsible. 

It  becomes  apparent  at  once  then  that  the  opponents  of  the 
McLagon  contention  as  to  the  specificness  of  salicylic  acid  in 
rheumatism  have  had  good  evidence  upon  which  to  base  their 
position,  and  as  much  of  this  evidence  is  the  result  of  practical 
experience  it  is  the  most  difficult  sort  to  disprove.  The  evolu- 
tion of  salicyl  compounds  which  are  not  intolerable  to  the 
stomach,  heart,  and  kidneys,  whereby  adequate  dosage  has  been 
rendered  possible,  is  doing  away  with  much  of  it;  increase  in 
diagnostic  knowledge  and  ability  is  doing  away  with  a  great 
deal ;  and  it  would  seem  probable  that  the  advent  of  dry  hot  air 
as  an  efficient  auxiliary  measure  for  the  improvement  of  local 
and  general  metabolism  and  assimilation  might  remove  the 
rest. 

Be  that  as  it  may,  the  fact  is  readily  demonstrable  to-day  that 
the  extinction  of  almost  any  attack  of  true  rheumatism,  how- 
ever severe,  can  be  as  satisfactorily  and  positively  accomplished 
by  the  proper  administration  of  salicylic  acid  supported  by  dry 
hot  air  treatments  as  can  an  attack  of  any  other  disease  by  its 
appropriate  specific  drug  management,  not  excepting  malaria. 
That  the  thermal  agent  is  only  entitled  to  credit  as  an  auxiliary 


Rheumatism.  105 

measure  through  which  to  remove  conditions  that  interfere 
with  the  exercise  of  the  characteristic  salicyl  influence,  is 
proven  by  the  fact  that  few  cases  respond  satisfactorily  to  dry 
hot  air  when  this  agent  is  used  alone. 

The  results  of  the  employment  of  dry  hot  air  in  the  manage- 
ment of  rheumatism  then  may  possibly  forge  still  another  link 
for  McLagon's  chain  of  analogy  and  constitute  another  bit  of 
confirmatory  evidence  as  regards  his  contention  that  salicylic 
acid  is  a  specific  remedy  in  the  treatment  of  this  disease. 

General  Application. — The  physiological  action  of  this 
measure  at  once  suggests  its  employment  with  patients  who 
have  become  debilitated  by  a  protracted  attack  of  the  disease, 
or  when  systemic  toxaemia  is  pronounced;  the  validity  of  the 
inference  is  confirmable  by  practical  experience. 

DIAGNOSIS. 

The  correct  diagnosis  of  a  condition  presenting  clinical  phe- 
nomena of  an  apparently  rheumatic  nature  is  a  matter  of  the 
first  importance,  and  as  anti-rheumatic  treatment  is  not  only 
futile  but  occasionally  positively  injurious,  in  some  conditions 
closely  resembling  this  disease,  the  diagnosis  should  be  made 
before  treatment  is  instituted.  The  amount  of  undeserved 
opprobrium  that  rheumatism  has  been  made  to  bear  may  be 
inferred  from  the  fact  that  probably  three-fourths  of  the  cases 
that  were  diagnosticated  as  rheumatism  previously  to  three 
vears  ago,  were  not  rheumatism  at  all,  and  further,  involved 
the  practical  point  of  being  disease  processes  that  would  not 
respond  happily  to  anti-rheumatic  therapeusis. 

The  more  important  conditions  from  which  it  is  to  be  differ- 
entiated are  as  follow :  arthritis  deformans ;  neuritis ;  neural- 
gias; myalgias;  osteomyelitis;  tubercular,  syphilitic,  gonor- 
rheal,  and  traumatic  osteitis  and  periosteitis;  and  non-rheu- 
matic synovitis  and  myositis,  which  last  is  of  rare  occurrence, 
but  sometimes  offers  a  diagnostic  problem  which  may  be  puz- 
zling in  the  highest  degree  for  a  short  time.  Pressure  from 
tumors,  especially  those  occurring  in  the  retroperitoneal 
lymphatics  and  which  involve  the  nerve  trunks  and  plexuses  in 
these  vicinities,  orthopedic  deformities — especially  flat  foot, — 


106  Therapeutics  of  Dry  Hot  Air. 

and  the  occupation  neuroses  in  their  earlier  stages,  deserve  a 
much  greater  amount  of  consideration  in  this  connection  than 
is  generally  accorded  to  them. 

The  two  first-  and  two  last-mentioned  conditions  are  con- 
cerned in  by  far  the  greater  number  of  diagnostic  errors,  and 
in  these  also  early  recognition  is  of  great  importance.  The 
diagnosis  of  true  inflammatory  rheumatism  is  so  well  set  forth 
in  the  ordinary  text-books  and  the  clinical  picture  is  so  familiar 
that  further  consideration  in  this  volume  is  uncalled  for. 

ILLUSTRATIVE  CASES. 

Acute  Rheumatism. — I  was  consulted  by  Mr.  G.  L.  M., 
forty-five  years  old,  February  28,  1899.  He  had  had  inflam- 
matory rheumatism  two  or  three  times  before,  the  last  attack 
preceding  this  one  having  occurred  in  1891,  at  which  time  he 
was  ill  for  three  months,  both  ankles  and  the  right  great  toe 
joint  being  involved.  His  father  had  suffered  frequently  and 
severely  with  inflammatory  rheumatism  (?)  and  his  mother 
had  been  gouty  (  ?).  When  I  was  called  he  had  been  suffering 
for  two  weeks,  the  left  hip  being  the  part  involved,  and  during 
this  time  he  informed  me  that  he  had  been  taking  salophen 
and  alkalithia  constantly,  with  no  result.  The  symptoms  had 
increased  rapidly  in  intensity  during  the  preceding  two  days, 
and  he  had  had  no  sleep  for  twenty-four  hours  and  very  little 
for  forty-eight  hours.  Joint  was  extremely  sensitive  to  manipu- 
lation and  pressure.  Dry  hot  air  was  applied  locally  and  the  pain 
was  entirely  gone  in  twenty  minutes.  At  the  conclusion  of  the 
treatment  the  joint  could  be  manipulated  within  certain  limits 
without  any  pain.  I  requested  the  patient  to  call  at  my  office 
the  following  morning  if  he  was  able.  Salophen  was  prescribed 
internally,  one  gram  three  times  a  day. 

He  appeared  at  the  time  appointed,  March  ist,  reporting  that 
he  had  experienced  no  pain  after  the  treatment  of  the  preceding 
day  until  this  morning  on  arising  from  bed,  but  that  since  then 
it  had  been  slightly,  but  constantly  present.  He  was  on  his  way 
to  business  and  had  "  only  dropped -in  to  let  me  know  that  he 
was  all  right."  I  persuaded  him  to  allow  me  to  treat  him  again, 
but  he  would  not  relinquish  his  intention  of  attending  to  his 
business.  I  treated  him  for  an  hour,  with  entire  relief  of  pain 
as  before,  and  he  promised  to  report  the  next  day. 

March  2d.  Patient  called  this  morning,  informing  me  that 
half  an  hour  after  leaving  my  office  yesterday  he  had  suffered 
from  an  acute  attack  of  pain,  lasting  about  ten  minutes,  which 


Rheumatism,  107 

had  then  subsided,  and  he  had  felt  it  no  more  until  this  morn- 
ing, when,  for  half  an  hour,  it  was  quite  severe.  Another 
remonstrance  as  to  his  continuing  to  perform  his  business  duties 
was  met  by  the  assertion  that  to  stop  at  this  time  would  entail 
financial  loss  that  he  was  unwilling  to  sustain,  and  that  as  long 
as  he  continued  as  comfortable  and  as  free  from  pain  as  he  was 
then  he  would  rather  keep  about  his  business  and  take  a 
longer  time  for  his  recovery.  He  was  treated  and  requested 
to  report  the  next  day. 

March  3d.  No  pain  since  last  treatment,  but  feels  a  dull 
soreness  in  parts,  which  is  growing  steadily  less.  Dry  hot  air 
was  again  administered.  Patient  desired  to  stop  his  salophen, 
but  it  is  unnecessary  to  say  was  ordered  to  continue.  He  did 
not  call  again  until  March  8th,  when  he  reported  having  had 
slight  twinges  of  pain  always  in  the  morning  on  arising  and 
occasionally  during  the  day,  but  of  steadily  decreasing  severity 
since  the  last  treatment.  This  morning  for  the  first  time  since 
the  attack  began,  he  had  been  entirely  free  from  pain  of  any 
sort.  He  laughingly  derided  me  for  having  desired  to  keep 
him  in  bed  and  said,  as  I  supposed  in  joke,  that  he  wasn't 
"  going  to  take  any  more  of  those  powders." 

March  nth.  Patient  had  continued  to  feel  so  well  after  his 
last  call  that  he  had  carried  out  his  threat  of  stopping  the  salo- 
phen, and  yesterday  he  began  to  suffer  again.  Resumed  salo- 
phen, and  toward  evening  grew  more  comfortable,  but  this 
morning  pain  is  again  quite  severe.  Dry  hot  air  gave  its 
customary  immediate  relief,  but  patient  was  going  out  of 
town  and  could  not  call  again  for  treatment  until  two  days 
after. 

March  I3th.  Reports  freedom  from  pain  all  day  on  the 
nth,  but  it  was  present  considerably  yesterday  and  this 
morning.  Dry  hot  air  administered  with  the  usual  happy 
result. 

March  I4th.  Slipped  on  a  curbstone  while  running  to  catch 
a  car  yesterday,  wrenching  the  affected  hip  badly.  Suffered 
from  excruciating  pain  for  an  hour,  which  then  subsided,  leav- 
ing intense  soreness  and  throbbing  which  were  present  this 
morning.  Treated  with  dry  hot  air,  but  pain,  for  the  first  and 
only  time,  was  not  entirely  relieved,  and  the  patient  left  my 
operating  room  with  a  slight  limp. 

March  I5th.  He  appeared  at  my  office  at  7.30  A.  M.,  report- 
ing that  pain  returned  quite  severely  four  hours  after  treat- 
ment, and  had  stayed  with  him  pretty  sharply  ever  since.  In- 
sisted that  he  could  not  leave  his  business  and  remain  quietly  at 
home,  and  I  suggested  that  he  be  treated  three  times  that  day, 


io8  Therapeutics  of  Dry  Hot  Air. 

to  which  he  consented.  I  treated  him  at  9  A.  M.,  at  2  P.  M.  and 
7  P.  M.,  with  the  result  that  he  kept  about  his  business  and 
had  practically  no  pain. 

March  i6th.  Came  to  my  office  at  9  A.  M.,  reporting  that 
he  had  had  no  pain  until  eight  o'clock  after  rising  from  bed, 
and  then  only  slight  dull  twinges.  Administered  dry  hot  air 
at  9  A.  M.  with  the  usual  satisfactory  result,  and  requested  him 
to  call  again  for  treatment  at  two  in  the  afternoon.  He  did  so, 
informing  me  that  he  had  had  no  pain  at  all  since  morning,  and 
expressed  himself  as  feeling  better  generally  and  locally  than 
at  any  time  since  the  attack  began.  Ordered  him  to  come  in 
the  evening  if  he  felt  the  slightest  return  of  the  pain.  I  did  not 
see  him  again  for  a  week. 

On  March  23d  he  came  to  my  office  early  in  the  afternoon, 
supporting  his  right  arm  with  his  left,  suffering  with  intense 
pain  in  his  right  shoulder,  which  he  said  had  commenced 
about  ii  A.  M.  The  slightest  movement  of  the  affected  joint 
forced  him  to  cry  out,  and  when  I  had  succeeded,  with  great 
difficulty  and  the  utmost  care  and  gentleness,  in  removing  his 
clothing  preparatory  to  treatment,  he  was  shaking  like  a  leaf. 
I  applied  dry  hot  air  with  the  usual  result;  pain  was  relieved 
in  ten  minutes.  At  the  end  of  the  treatment  he  could  move 
his  arm  sufficiently  to  get  into  his  clothing  without  assistance, 
was  perfectly  free  from  pain,  but  could  not  raise  his  elbow 
to  within  more  than  three  inches  of  the  level  of  his  shoulder. 
He  had  had  no  trouble  with  the  hip  since  the  last  treatment, 
and  I  will  say  here  that  the  recovery  of  this  joint  was  complete 
and  remained  so.  I  directed  him  to  call  again  for  treatment 
in  the  evening.  At  that  time  he  was  suffering  slightly,  but  was 
able  to  remove  his  clothing  for  treatment  without  assistance. 
Dry  hot  air  was  administered  and  directions  given  to  call  again 
next  morning  if  he  was  in  any  pain  at  that  time.  I  did  not 
see  him  again  until  March  25th,  when  he  called  to  tell  me  that 
he  had  had  some  slight  twinges  of  pain  during  the  night  fol- 
lowing the  last  treatment,  but  had  remained  free  from  it  ever 
since.  I  requested  him  to  call  immediately  if  any  more  symp- 
toms appeared,  and  to  continue  the  salophen  for  two  weeks. 
Five  days  afterward,  on  March  3Oth,  he  called,  complaining 
of  a  dull  aching  in  the  right  shoulder  which  I  dissipated 
with  one  treatment,  and  that  was  the  last  of  the  trouble. 

I  quote  this  particular  case,  not  because  of  the  rapidity  with 
which  a  cure  was  obtained,  but  because  it  is  very  instructive 
in  this  connection  when  the  different  phases  which  it  exhibited 
are  studied  carefully. 


Rheumatism.  109 

First,  it  was  treated  exclusively,  as  far  as  dry  hot  air  was 
concerned,  with  the  local  application. 

Second,  it  illustrates  forcibly  the  power  of  dry  hot  air  to 
rapidly  alleviate  rheumatic  pain. 

Third,  it  exemplifies  the  necessity  of  accompanying  dry  hot 
air  applications  with  appropriate  internal  medication,  as 
shown  by  the  severe  return  of  symptoms  in  the  same  old  place 
on  March  loth  and  nth,  after  the  salophen  had  been  prema- 
turely discontinued. 

Fourth,  when  I  state  that  the  total  length  of  time  during 
which  this  patient  was  under  treatment,  viz.,  one  month,  is 
longer  than  that  required  for  the  recovery  of  any  other  case 
of  rheumatism,  however  severe,  that  I  have  ever  submitted 
to  this  management,  and  when  we  compare  this  period  with 
that  usually  required  for  recovery  from  an  ordinarily  severe 
rheumatic  attack  under  other  methods  of  treatment,  it  ex- 
emplifies in  a  very  gratifying  manner  the  power  of  dry  hot  air 
to  shorten  the  duration  and  lessen  the  symptomatic  intensity 
of  the  disease. 

Here  was  a  severe  case  in  active  eruption  in  a  patient  ex- 
hibiting a  strongly  rheumatic  tendency;  he  kept  up  and  about 
his  business  all  the  time,  and  yet,  in  spite  of  this  utter  and  con- 
stant disregard  of  one  of  the  prime  essentials  to  be  secured  in 
the  treatment  of  inflamed  joints,  viz. :  rest,  the  attack  was  ex- 
tinguished completely  in  a  month.  Not  only  this,  but  the 
patient  had  been  kept  entirely  free  from  pain  the  vastly  greater 
part  of  the  time  during  that  month ;  an  achievement  which 
could  not  be  claimed  as  among  the  possibilities  for  any  other 
treatment  with  which  I  am  acquainted,  however  perfect  might 
be  the  rest  secured.  When  the  patient  can  be  kept  at  rest  it  has 
uniformly  been  my  experience  that  an  attack  of  acute  rheu- 
matism is  extinguished  in  from  five  to  ten  days,  whatever  the 
degree  of  severity  exhibited  when  it  comes  under  treatment, 
and  I  have  had  cases  of  moderate  severity  recover  with  but 
three  applications. 

Chronic  Rheumatism. — Mr.  J.  D.,  brass  worker,  33  years 
old,  was  referred  to  us  for  treatment  by  Dr.  James  Stretch, 


HO  Therapeutics  of  Dry  Hot  Air. 

of  Stafford  Springs,  Conn.,  and  was  admitted  to  the  sanitarium 
November  u,  1903.  He  had  been  ill  with  rheumatism  for 
the  preceding  ten  months,  which  had  involved  nearly  all  of  the 
large  joints  in  his  body  at  different  times.  When  he  was  ad- 
mitted the  disease  was  manifesting  itself  by  pain  and  soreness 
upon  movement"  in  both  shoulders,  the  left  being  the  worse,  the 
right  knee  and  the  left  ankle,  the  knee  and  ankle  being  some 
swollen.  He  was  much  debilitated. 

He  was  put  upon  aspirin,  one  gram  four  times  daily,  and 
during  the  next  nine  days  was  given  five  body  dry  hot  air 
treatments,  four  applications  of  the  mechanical  vibrator  to  his 
posterior  spinal  nerve  roots,  five  general  tonic  applications  of 
static  electricity,  one  spinal  galvanization,  and  two  applications 
of  the  negative  pole  of  the  galvanic  current  slowly  interrupted, 
to  his  left  shoulder. 

During  the  last  three  of  these  nine  days  he  had  been  entirely 
free  from  pain  and  joint  disability  and  felt  so  much  better  gen- 
erally that  he  decided  to  return  to  work,  against  my  advice  it 
is  unnecessary  to  state.  Four  days  after  his  return  to  work 
he  sustained  a  sharp  return  of  the  trouble  in  both  shoulders. 
This  yielded  to  aspirin  completely  in  two  days,  however,  and 
he  heard  no  more  of  it. 

This  case  is  particularly  instructive  because  the  patient  came 
under  our  care  directly  from  a  large  public  hospital  where  he 
had  had  several  weeks  of  the  best  ordinary  anti-rheumatic  man- 
agement without  positive  result.  The  addition  of  dry  hot  air 
and  the  other  physical  measures  to  the  therapeutical  regimen, 
however,  produced  the  above  marked  and  very  satisfactory 
result  in  nine  days. 

TREATMENT. 

Five  years  ago  in  an  article  concerning  dry  hot  air,  the 
writer  expressed  the  opinion  that  a  "  new  leaf  "  was  about  to 
be  turned  in  the  history  of  the  clinical  results  of  rheumatic 
therapeusis,  and  subsequent  experience  has  justified  the  infer- 
ence then  noted.  It  is  in  this  disease  that  the  agent  has  won 
some  of  its  most  enduring  laurels.  Its  mode  of  application  and 
the  results  derivable  therefrom  are  now  well  defined,  and  the 
treatment  of  the  disorder  has  reached  a  point  where  it  can  no 
longer  be  regarded  as  a  reproach  to  the  profession. 

Clinical  Forms  of  Rheumatism. — It  is  necessarv  to  divide 


Rheumatism.  ill 

rheumatic  cases  into  but  two  classes  for  therapeutic  purposes, 
acute  and  chronic. 

If  the  acute  stage  is  properly  and  thoroughly  managed  there 
will  very  rarely  indeed  be  any  chronic  stage  to  consider,  but 
this  could  not  have  been  affirmed  before  the  therapeutical  ad- 
vent of  dry  hot  air.  The  cause  of  chronicity  has  resided  mostly 
in  impairment  of  local  and  general  metabolism,  through  the 
influence  of  long-continued  pain  and  the  long-continued  pres- 
ence of  rheumatic  toxins  in  the  blood  and  tissues  of  the 
affected  regions,  by  reason  of  which  it  became  impossible  for 
the  remedies  ingested  to  be  assimilated  effectively  by  such 
tissues.  Dry  hot  air,  through  its  power  of  relieving  stasis  and 
stimulating  sluggish  metabolism,  renders  rapid  and  effective 
the  assimilation  of  the  appropriate  remedies,  the  general  ner- 
vous system  is  not  therefore  subjected  to  drug  pain  or  un- 
endurable toxin  depression  and  recovery  is  rapid  and  satis- 
factory. 

It  is  probably  not  practicable  to  drop  the  term  "  chronic  " 
rheumatism  entirely  at  present  because  inefficient  medication 
or  conditions  of  general  debility  present  when  the  infection 
was  contracted,  or  which  supervene  because  of  a  protracted 
attack,  will  combine  to  cause  chronicity;  as  previously  sug- 
gested, however,  great  care  should  be  exercised  in  making  a 
diagnosis  of  chronic  rheumatism. 

Complications. — It  is  hardly  necessary  to  state  that  any 
other  pathological  conditions  which  may  exist  when  an  attack 
of  rheumatism  is  sustained  should  receive  attention.  Some- 
times the  system  is  so  depressed  by  such  a  complication  that 
the  rheumatism  cannot  be  removed  until  such  complication  has 
been  attended  to.  We  once  had  a  patient  under  treatment  for 
rheumatic  polyarthritis  for  three  weeks  and  were  able  to  se- 
cure only  temporary  relief.  At  last  it  was  discovered  that  she 
had  a  tapeworm,  a  fact  of  which  she  had  previously  had  no 
suspicion.  After  the  removal  of  an  eighteen-foot  parasite  her 
recovery  was  immediate  and  perfect. 

Local  Dry  Hot  Air  Application. — The  local  treatment 
is  usually  the  only  thermo-therapeutical  modality  which  it  is 
necessary  to  employ  in  the  treatment  of  true  rheumatism.  If 


1 1 2  Therapeutics  of  Dry  Hot  A  ir. 

more  than  one  joint  are  affected  as  many  as  possible  of  them 
should  be  treated  at  once  with  as  many  separate  apparatuses. 
It  should  be  applied  at  least  twice  a  day  at  a  temperature  of 
from  350°  to  400°  F.  for  an  hour  until  the  soreness  and  pain  in 
the  parts  have  entirely  disappeared.  When  the  pain  returns 
after  the  treatment  the  same  may  be  applied  again  immediately. 
Usually  fifteen  or  twenty  minutes  will  entirely  remove  the 
pain  from  the  most  violent  cases,  and  it  remains  quiescent  for 
a  variable  period,  ordinarily  from  four  to  six  hours.  By  re- 
peating the  application  whenever  the  pain  returns  the  patient 
can  be  kept  practically  free  from  marked  discomfort  during 
the  whole  of  his  convalescence,  the  inauguration  of  which 
usually  coincides  with  his  first  dry  hot  air  treatment. 

After-Care. — Suppression  of  the  functions  of  affected  joints 
after  the  thermal  application  is  always  helpful,  but  not  always 
absolutely  necessary.  Massage  and  passive  movement  are 
always  unnecessary  and  sometimes  interfere  markedly  with  the 
patient's  comfort,  either  immediately  or  shortly  afterwards. 
The  limb  may  be  done  up  in  absorbent  cotton  or  flannel,  but 
liniments  or  other  external  applications  are  usually  uncalled 
for  and  useless. 

General  Dry  Hot  Air  Application. — The  body  dry  hot 
air  treatment  is  always  useful  and  occasionally  necessary  for 
removing  metabolic  impairment  from  systemic  toxaemia  and 
debility,  but  for  the  routine  treatment  of  the  disease  it  is  not 
essential. 

An  important  advantage  contingent  upon  the  employment 
of  dry  hot  air  applications  in  rheumatism  is  that  as  local  metab- 
olism is  thereby  kept  at  its  point  of  greatest  activity,  assimi- 
lation of  medicines  by  the  tissues  of  the  infected  regions  is  rapid 
and  complete;  less  of  the  drug  is  therefore  required  to  be  in- 
troduced into  the  general  circulation  and  less  systemic  dis- 
turbance ensues  therefrom.  As  a  matter  of  fact,  when  dry  hot 
air  is  administered  in  conjunction  with  the  proper  salicyl  com- 
pound systemic  disturbance  of  any  sort  or  degree  is  of  ex- 
tremely rare  occurrence. 


R/teu  ma  tism.  113 

Additional  Remedial  Measures. 

Diet. — Rigid  restriction  of  the  diet  within  narrow  limits  in 
this  disease  is  not  of  nearly  as  much  importance  as  is  ordi- 
narily supposed.  Its  regulation  should  be  governed  by  the 
manifest  needs  of  the  patient's  economy  and  the  effects  of  the 
unaccustomed  conditions  surrounding  him  as  regards  lack  of 
exercise,  etc.,  rather  than  by  the  mere  fact  that  he  has  rheu- 
matism. The  disease  has  in  the  past  been  so  inextricably  en- 
tangled with  lithaemic  and  gouty  conditions  that  the  diet  has 
been  made  to  assume  an  unduly  specific  character.  The  patient 
should  be  fed  as  would  a  person  sick  with  any  other  disease 
which  had  impaired  his  power  of  digestion  and  assimilation, 
and  whose  muscular  and  nervous  systems  were  weakened  by 
toxaemia  and  sluggish  from  lack  of  exercise.  If  his  digestive 
powers  are  equal  to  beefsteak  it  may  be  given  him  without  fear. 

Plenty  of  liquid — in  the  form  of  milk  (one  quart  per  day) 
or  water  (carbonated,  plain,  or  in  lemonade)  is  essential  for  the 
patient's  best  good. 

Drugs. 

From  what  has  been  said  in  previous  sections  it  will  be  seen 
that  salicylic  acid  in  some  form  should  always  constitute  one 
of  the  principal  elements  of  anti-rheumatic  therapy.  Because 
of  its  irritative  tendencies  toward  the  stomach  and  kidneys 
and  its  depressing  influence  upon  the  heart,  however,  it  some- 
times so  impairs  digestion,  assimilation,  and  metabolism  either 
general  or  local,  or  both,  that  it  destroys  its  own  effectiveness 
by  rendering  impossible  its  ingestion  in  sufficient  quantity ; 
hence  the  selection  of  the  particular  form  in  which  it  is  to  be 
administered  is  important.  Those  most  worthy  of  consideration 
are  aspirin,  salicin,  sodium  salicylate.  salophen,  and  methyl 
salicylate,  and  their  desirability  according  to  our  experience  is 
in  the  order  in  which  they  are  named. 

Aspirin. — This  drug  in  doses  of  3  or  4  grams  per  day  is 
usually  a  perfectly  effective  anti-rheumatic  and  very  rarely 
indeed  produces  any  irritation  of  the  stomach  or  kidneys  or 
depression  of  the  heart.  Occasionally  slight  tinnitus  or  heart- 


1 14  Tkerapfiftics  of  Dry  Hot  Air. 

burn  follows  its  use,  and  rarely  a  patient  is  encountered  who 
cannot  take  it  at  all. 

Salicin. — The  bitter  principle  of  willow  bark  is  nearly  as 
effective,  but  must  be  given  in  much  larger  quantities  (4  to  10 
grams  daily),  and  the  bulk  is  objectionable.  Salicin  has  the 
advantage  over  all  the  others  of  being  an  excellent  stomachic, 
and  constitutes  a  most  useful  succedaneum  to  sodium  salicylate 
when  the  latter  drug  has  impaired  digestion;  it  serves  admi- 
rably to  remove  the  gastric  debility  as  well  as  to  keep  up  the 
salicyl  saturation  of  the  blood. 

Sodium  Salicylate. — The  gastric  and  renal  consequences 
of  administering  this  substance  in  full  doses  need  only  to  be 
mentioned  in  order  to  be  appreciated,  but  in  cases  where  it  is 
tolerated  no  drug  performs  better  service. 

Salophen. — A  very  useful  drug  which  may  be  safely  given 
in  gram  doses  three  times  daily  and  does  good  analgetic  work 
for  a  day  or  two,  but  in  order  to  get  a  marked  and  sustained 
curative  action  larger  quantities  are  usually  required  and 
then  the  heart  is  apt  to  suffer.  It  is,  however,  extremely 
valuable  in  some  cases,  and  I  shall  refer  to  it  again  in  con- 
nection with  sciatica. 

Methyl  Salicylate. — This  preparation  is  sometimes  given  by 
the  mouth,  but  our  experience  has  been  that  its  use  should 
preferably  be  restricted  to  external  application  after  dry  hot 
air  treatments  with  those  patients  who  cannot  take  any  of  the 
others  in  sufficient  doses  per  os.  Three  or  four  thicknesses 
of  gauze  are  laid  smoothly  over  the  joint  affected,  5  or  10  grams 
of  methyl  salicylate  soaked  into  it,  and  gutta-percha  tissue 
wrapped  around  the  whole  and  retained  in  place  by  a  roller 
bandage.  It  enters  the  circulation  by  absorption  through  the 
skin. 

Alkalies. — The  practice  of  administering  alkalies  in  this 
affection  with  or  without  a  salicyl  compound  is  a  common  one, 
but  modern  conceptions  of  the  pathology  of  the  disease  do  not 
furnish  a  logical  indication  for  it,  and  although  it  does  no  harm, 
I  have  never  been  able  to  convince  myself  that  it  did  any  good, 
and  have  abandoned  it 

It  will  not  frequently  be   found  necessary  to  go  beyond 


Rheumatism.  115 

aspirin.  This  drug  is  not  miscible  with  water,  but  by  thor- 
oughly incorporating  it  with  an  equal  quantity  of  powdered 
sugar  it  may  be  suspended  in  the  liquid,  and  is  best  given  in 
this  manner,  or  in  konseals. 

In  chronic  cases,  where  pain  is  not  a  factor  demanding 
immediate  attention,  it  is  well  to  precede  the  first  dry  hot  air 
treatment  by  two  or  three  doses  of  the  salicyl  selected.  We 
thus  secure  a  preparatory  saturation  of  the  patient's  system 
and  the  case  seems  to  progress  more  rapidly  thereafter.  In 
acute  cases,  however,  immediate  relief  of  the  constant  harass- 
ing pain  is  imperative,  and  the  thermal  application  should  be 
employed  at  once. 

Salines. — As  in  every  other  general  infection,  the  bowels 
must  be  kept  freely  open,  and  salines  are  the  best  agents  to 
employ  for  this  purpose. 

Electricity. 

The  electrical  currents  usually  play  but  a  secondary  part  in 
the  treatment  of  rheumatism  when  dry  hot  air  is  available. 
When  dry  hot  air  is  not  at  hand,  however,  and  sometimes  in 
combination  with  dry  hot  air  they  are  extremely  useful  and 
may  be  applied  as  follows : 

The  Static  Current. — The  spray  over  the  spine  for  its 
general  tonic  effect,  and  the  brush  discharge  for  from  thirty 
to  forty  minutes  over  the  seat  of  the  inflammatory  process  for 
sedation,  relief  of  swelling,  and  improvement  of  metabolism. 
Sometimes  the  Morton  wave  current  is  extremely  helpful  in 
this  situation. 

The  Magnetic-Induced  Current. — Rapidly  interrupted  cur- 
rent from  long,  fine-wire  coil  passed  directly  through  the  tissues 
affected,  for  sedation  and  improvement  of  metabolism. 

The  Voltaic  Current. — The  positive  pole  over  the  affected 
tissues  in  acute  cases,  current  uninterrupted  will  frequently 
give  temporary  relief  from  the  pain  and  should  be  tried  first, 
but  sometimes  the  polarities  must  be  reversed  to  obtain  this 
result.  We  can  tell  which  only  by  trying.  Occasionally  a  case 
is  encountered  wherein  a  muscle  remains  sore  upon  movement 
after  the  attack  has  apparently  entirely  ended,  and  here  a  few 


1 16  Therapeutics  of  Dry  Hot  Air. 

applications  of  the  negative  pole  of  the  slowly  interrupted 
galvanic  current  to  the  complaining  structure  will  usually  dis- 
sipate the  trouble.  In  addition  to  its  sedative  action  the 
galvanic  current  exercises  a  curative  influence  upon  the  disease 
through  its  power  of  stimulating  tissue  metabolism.  Its  action 
in  this  direction  is  probably  identical  with  that  of  dry  hot 
air,  but  much  less  powerful.  When  the  part  affected  is  a  hand, 
foot,  wrist,  or  ankle,  the  use  of  a  hot-water  bath  electrode  in 
which  the  member  can  be  immersed  is  much  more  effective. 
From  5  to  15  milliamperes  may  be  used  for  from  ten  to  fifteen 
minutes. 

Franklinism  is  the  most  useful  of  the  electric  modalities 
in  rheumatism. 

CHRONIC    RHEUMATISM. 

This  term  is  used  less  and  less  frequently  as  our  diagnostic 
knowledge  and  ability  increase. 

Treatment. — The  management  differs  in  no  essential  par- 
ticular from  that  of  the  acute  form  except  that  as  a  considerable 
degree  of  general  debility  is  nearly  always  present,  the  body 
treatment  assumes  a  position  of  some  importance  in  its  man- 
agement. It  may  be  administered  two  or  three  times  a  week. 

Because  of  this  general  debility  other  tonic  measures  such 
as  static  sparks,  the  wave  current,  galvanism,  mechanical  vibra- 
tory stimulation,  etc.,  are  most  helpful.  When  dry  hot  air  is 
not  available  these  agents  will  render  good  service. 

The  drug  treatment  differs  in  only  one  particular  from  that 
of  the  acute  form,  viz. :  the  addition  of  general  tonics  to  the 
salicyl  regimen. 


CHAPTER  VI. 
LOCAL  SEPTIC  INFECTION. 

Modifications  of  Clinical   Conditions 
producible  zvith  Dry  Hot  Air. 

Local  Application. 

First,  rapid  relief  of  pain  if  applied  before  suppuration 
has  become  established,  and  partial  relief  if  this  event  has 
already  supervened.  If  confined  pus  is  present  the  pain  is 
sometimes  increased. 

Second,  abrupt  arrest  of  the  tendency  of  the  disease  to  pro- 
gressively involve  structure  after  structure,  and  sharp  localisa- 
tion of  the  process  and  products  of  inflammation. 

General  Application. 

First,  a  marked  stimulation  of  the  vital  functions  indicated 
by  improvement  in  the  circulatory  phenomena  before  the 
patient  leaves  the  apparatus,  which  is  not  followed  by  any  per- 
nicious reaction. 

Second,  rapid  relief  of  the  nerve  centers  from  a  large  degree 
of  toxin  depression,  because  of  the  increase  effected  in  the] 
process  of  elimination. 

Third,  abrupt  arrest  of  the  tendency  of  the  process  to  involve 
other  structures,  because  of  the  augmented  physiological  re- 
sistance of  the  threatened  tissues  due  to  the  vital  stimulation* 
and  elimination  effected. 

Fourth,  avoidance  of  evil  reaction  from  drug  stimulation, 
because  an  amount  of  depression  sufficient  to  demand  the  em- 
ployment of  such  remedies  does  not  ordinarily  obtain  after 
the  administration  of  body  treatments  has  been  commenced. 

One  of  the  most  dreaded  of  the  pathological  states  encoun- 
tered with  a  moderate  degree  of  frequency  to-day  is  septic 
infection.  In  spite  of  the  most  careful  observance  of  the 


1 1 8  Therapeutics  of  Dry  Hot  A  ir. 

elaborate  aseptic  and  antiseptic  technique  which  has  been  de- 
veloped from  the  never-to-be-forgotten  work  of  Sir  Joseph 
Lister,  pathogenic  micro-organisms  will  sometimes  gain  a 
lodgment  in  operation  wounds,  bringing  in  their  train  the 
usual  accompaniment  of  harassing  anxiety,  protracted  illness, 
suffering,  and  sometimes  death;  cuts  and  crushing  injuries  are 
frequently  infected  at  the  time  they  are  sustained,  or  neglected 
then  and  infected  later.  Prevention  is,  of  course,  the  best 
treatment,  but  in  many  cases  prevention  fails  and  in  others  it 
is  impossible  of  attainment,  so  that  some  effective  agent  for 
combating  established  septic  infection  will  always  be  in  demand. 
Dry  hot  air  satisfies  this  demand  in  a  gratifying  manner. 

RATIONALE    OF    THERMOTHERAPY. 

Etiology  and  Pathology. — In  order  to  comprehend  fully 
the  logic  of  the  application  of  the  agent  to  this  disease  let  us 
glance  for  a  moment  at  the  pathological  conditions  obtaining 
and  which  it  is  the  aim  of  treatment  to  overcome. 

The  primary  etiological  factor  consists  of  the  lodgment  in 
the  lymph  spaces  of  pathogenic  micro-organisms.  After  this 
event  has  occurred,  one  of  two  things  will  happen: 

First,  what  we  will  denominate  the  patient's  constitutional 
resistive  power,  may  be  intense  enough  to  enable  the  cells 
composing  the  invaded  tissue  to  destroy  the  infective  organ- 
isms, in  which  case  nothing  further  will  be  heard  from 
them. 

Second,  the  patient's  normal  constitutional  vitality  may  be 
lowered  from  some  cause,  or  the  resisting  power  of  the  tissues 
attacked  may  be  weakened,  as  by  impairment  of  the  trophic 
nervous  control  from  injury  or  shock,  for  instance,  in  which 
contingency  the  invading  organisms  find  a  pabulum  suitable 
for  their  development.  Once  established  they  multiply  with 
exceeding  rapidity,  spreading  colony  after  colony  into  the 
numerous  ramifications  of  the  lymphatic  system,  until  finally 
millions  of  bacteria  are  vomiting  toxins  upon  the  contiguous 
tissue  cells,  paralyzing  their  vitality  and  rendering  larger  and 
larger  areas  of  tissue  a  favorable  soil  for  further  germ  propa- 
gation. These  toxines,  together  with  the  ptomaines  resulting 


Local  Septic  Infection.  \  19 

from  abnormal  tissue  metamorphosis,  are  taken  up  by  the 
general  blood  circulation  and  brought  into  contact  with  all  the 
nerve  centers  and  other  tissues  of  the  body,  exercising  there- 
upon a  most  viciously  depressing  influence,  whence  results  the 
evil  clinical  picture  so  harassingly  familiar  to  most  of  us  as 
"  blood  poisoning." 

Two  important  points  to  be  borne  in  mind  in  this  connection 
are,  first,  that  when  the  normal  resisting  power  of  the  tissues 
is  unimpaired  it  is  probable  that  they  are  capable  of  resisting 
any  ordinary  microbic  invasion ;  second,  that  most  of  the  com- 
mon pathogenic  germs  require  for  their  propagation  that  the 
conditions  most  favorable  to  their  development  as  regards 
the  temperature  of  their  environment,  etc.,  be  maintained  with 
a  moderate  degree  of  uniformity. 

Therapeutic  Indications. — The  objects  of  treatment  as 
deduced  from  the  above,  then,  would  be  as  follow: 

First,  so  to  modify  the  environment  of  the  colonies  of  micro- 
organisms as  to  accomplish  their  destruction,  inhibit  their 
development,  or  lessen  the  virulence  of  their  toxic  ema- 
nations. 

Second,  to  increase  the  physiological  resistance  of  the  in- 
fected organism  as  a  whole,  and  of  the  cells  composing  its 
tissues  as  individuals. 

Third,  to  eliminate  as  rapidly  and  profusely  as  possible  the 
toxins  already  in  the  circulation. 

The  local  and  general  applications  have  their  distinct  spheres 
of  action  in  this  disease,  and  it  will  assist  in  the  elucidation 
of  the  problem  before  us  if  we  consider  them  separately, 
bearing  in  mind  their  physiological  actions  as  described  in 
Chapter  II. 

Local  Application. — When  a  local  dry  hot  air  application 
is  made  to  one  of  the  extremities  of  the  body  exhibiting  the 
evidences  of  septic  infection,  the  following  sequence  of  events 
is  inaugurated  thereby. 

First,  the  reflex  stimulation  of  the  vasomotor  tracts  through 
thermic  irritation  of  the  nerve  endings  in  the  skin  relieves 
the  fluid  stasis  in  the  part,  thereby  lessening  the  pain. 

Second,  the  nutrition  and  cell  vitality  of  the  part  are  aug- 


1 20  Therapeutics  of  Dry  Hot  A  ir. 

mented  by  reflex  stimulation  of  the  trophic  nerve  supply 
through  the  same  influence. 

Third,  the  raising  of  the  temperature  of  the  part  en  masse 
disturbs  one  of  the  most  important  conditions,  which  it  is 
essential  should  be  maintained  unimpaired  if  the  propagation  of 
the  micro-organisms  is  to  reach  its  fullest  development. 

Fourth,  the  integumental  emunctories  are  stimulated  to 
greatly  increased  functionation. 

Resulting  from  this  we  find  that,  first,  the  lessening  of  the 
pain  quiets  the  patient's  nervous  system  in  direct  proportion  as 
the  relief  is  complete,  thereby  conserving  his  nervous  energy, 
and  the  relief  of  stasis  insures  a  plentiful  supply  of  raw  material 
in  the  form  of  an  augmented  blood  circulation,  out  of  which 
new  cells  may  be  built  up  to  take  the  place  of  the  debilitated, 
toxin-impaired  elements. 

Second,  the  augmented  trophic  impulses  result  in  advantage 
being  taken  of  this  increased  supply  of  raw  material  for  the 
rapid  formation  of  cells  possessing  a  heightened  vitality, 
whereby  the  resisting  power  of  the  tissue  is  at  once  greatly 
increased. 

Third,  the  raising  of  the  temperature  of  the  part  en  masse 
probably  exercises  an  inhibitory  influence  upon  the  develop- 
ment of  the  colonies  of  micro-organisms,  whereby  the  virulence 
and  quantity  of  the  toxins  emanating  therefrom  are  reduced 
in  direct  proportion  as  the  inhibition  is  profound. 

Fourth,  the  enormously  increased  functionation  of  the  sweat 
glands  removes  directly  from  the  parts  most  profoundly  influ- 
enced by  the  intoxication,  a  certain  proportion  of  the  noxious 
substances  which  had  previously  been  devitalizing  fresh  areas 
of  tissue  and  passing  into  the  general  circulation. 

As  a  consequence,  instead  of  the  destructive  process  spread- 
ing farther  and  farther  into  the  sound  tissues,  we  find  that  the 
cells  at  the  periphery  of  the  infection,  which  were  just  be- 
ginning to  feel  the  debilitating  influences  of  the  approaching 
destruction,  are  regenerated  and  carry  on  their  metabolic  and 
reconstructive  functions  with  a  normal,  or  perhaps  even  an 
increased,  degree  of  activity,  pushing  the  lines  of  healthy 
tissues  farther  and  farther  into  the  diseased  areas,  until 


Local  Septic  Infection.  1 2 1 

finally  the  pathological  mass  is  entirely  replaced  by  healthy 
tissue  and  the  patient  has  recovered,  frequently  without  even 
a  slough. 

When  a  collection  of  pus  is  present  before  treatment  is  begun, 
however,  it  is  necessary  that  it  be  evacuated,  neither  dry  hot 
air  or  any  other  measure  with  which  I  am  acquainted  being 
capable  of  producing  absorption.  When  pus  is  so  present  this 
agent  exhibits  another  valuable  attribute,  viz.,  the  power  to 
localize  the  inflammatory  process  very  closely  to  the  abscess 
cavity  when  a  stroke  of  the  knife  will  end  the  trouble  at  once 
and  forever. 

General  Application. — When  the  lymphatics  of  the  joint 
connecting  the  invaded  limb  with  the  trunk  have  become  in- 
fected, or  when  severe  general  toxaemia  is  present,  the  physio- 
logical effect  of  the  local  treatment  will  not  usually  be  sufficient 
to  produce  a  cure,  because  in  these  cases  foci  of  infection  are 
located  in  parts  so  situated  that  the  maximum  influence  of  the 
local  treatment  cannot  be  brought  to  bear  directly  upon  them. 
Under  these  conditions  it  becomes  necessary  to  call  up  all  of 
our  patient's  reserve  forces,  to  stir  his  vital  resistance  against 
the  invading  organisms  to  its  profoundest  depths,  and  the 
general  application  is  indicated. 

With  this  measure  we  cannot  invoke  the  directly  inhibitive 
influence  upon  germ  development  due  to  the  raising  of  the 
temperature  of  the  part  that  is  obtainable  with  the  local  treat- 
ment, because  the  mouth  temperature  is  rarely  increased  by  the 
body  treatment  beyond  3°  F.  above  the  normal,  and  this  is  not 
enough  to  appreciably  retard  the  growth  of  the  streptococcus ; 
indeed,  patients  very  frequently  exhibit  elevation  of  tempera- 
ture to  this  extent  and  more  when  they  enter  the  apparatus. 
The  greater  beneficial  power  of  the  body  treatment  consists  in, 
first,  the  greater  proportion  of  systemic  toxaemia  which  is 
eliminated  through  the  resultant  increased  functionation  of  the 
skin,  kidneys,  and  lungs,  whereby  the  vital  processes  are  more 
efficiently  relieved  of  impairment  and  depression ;  and,  second, 
its  gratifying  influence  in  stimulating  to  renewed  vigor  of 
function  the  deep  spinal  and  sympathetic  nerve  centers  that 
control  tissue  reconstruction  and  general  metabolism,  and  which 


122  Therapeutics  of  Dry  Hot  Air. 

have  been  overwhelmed  to  a  greater  or  less  extent  by  toxin 
accumulation  in  the  general  circulation.  By  its  use  is  secured 
an  increased  activity  in  the  resistance  to  further  invasion  on 
the  part  of  the  threatened  tissues,  and  at  the  same  time  a  more 
rapid  elimination  of  the  noxious  products  of  such  invasion  as 
has  already  taken  place. 

The  hyperleucocytosis  which  results  from  the  body  dry  hot 
air  application  has  been  looked  upon  as  an  important  element 
in  the  production  of  its  beneficent  effects  in  this  disease. 
Whether  this  phenomenon,  per  se,  has  anything  to  do  with  the 
case,  however,  cannot  be  determined  until  the  exact  role  of 
hyperleucocytosis  in  infectious  processes  is  ascertained,  and 
that  is  a  matter  for  the  future  to  decide. 

It  has  been  stated  that  local  dry  hot  air  applications  will 
always  increase  the  pain  attending  a  localized  septic  process 
if  pus  is  present,  and  that  it  is,  therefore,  of  value  as  a  diag- 
nostic test  for  detecting  the  presence  of  suppuration.  The 
writer  has  repeatedly  seen  the  pain  attending  localized  pus 
collections  markedly  relieved  by  local  dry  hot  air  applications, 
and  has,  therefore,  no  hesitation  in  expressing  his  absolute  lack 
of  confidence  in  this  measure  as  a  differential  diagnostic  test. 

ILLUSTRATIVE    CASES. 

With  regard  to  their  treatment  by  this  agent,  cases  of  septic 
infection  may  be  conveniently  divided  into  three  classes,  as 
follow : 

First,  those  in  which  the  infection  has  taken  place  in  a  limb, 
and  has  not  yet  invaded  the  lymphatics  of  the  joint  connecting 
the  member  with  the  trunk,  and  which  are  nearly  always  early 
cases. 

Second,  those  in  which  the  lymphatics  of  the  joint  connecting 
the  infected  limb  with  the  trunk  have  also  become  involved, 
but  where  the  original  focus  of  infection  or  other  tissues  have 
not  yet  become  so  profoundly  affected  as  to  demand  surgical 
removal. 

Third,  those  in  which  the  lymphatics  of  the  trunk  are  in- 
volved and  tissues  or  glands  are  so  hopelessly  diseased  as  to 
demand  immediate  operative  ablation. 


Local  Septic  Infection.  123 

The  following  reports  have  been  selected  with  a  view  to  illus- 
trating these  types ;  Case  I  exemplifies  the  first  class. 

Case  I. 

The  writer's  first  experience  with  dry  hot  air  in  the  treat- 
ment of  well-marked  septic  infection,  was  on  September  n, 
1900.  A  patient  was  admitted  to  the  sanitarium  on  that  date 
who  had  developed  a  septic  process  from  a  cut  on  the  little 
finger  of  her  left  hand  two  days  previously.  She  had  suffered 
intense  pain  for  thirty-six  hours,  temperature  had  reached 
103.5°  F.,  pulse  112,  and  marked  prostration  was  present.  The 
hand  and  wrist  had  become  involved,  and  red  streaks  followed 
the  lymphatics  up  the  arm  nearly  to  the  elbow.  A  local  dry  hot 
air  treatment  was  administered  in  the  hope  of  relieving  pain, 
which  it  accomplished  in  forty-five  minutes,  and  the  patient 
slept  for  the  first  time  in  twenty-four  hours.  That  evening,  to 
my  intense  surprise  and  gratification,  the  patient's  temperature 
had  dropped  to  99.2°  F.,  the  pulse  to  60,  and  the  pain  had  not 
returned  to  any  great  degree. 

By  the  next  morning  the  swelling  and  redness  had  nearly  dis- 
appeared, but  the  temperature  had  risen  again  to  101.4°  F., 
the  pulse  to  84,  and  the  pain  was  considerable  again.  She  was 
given  a  body  dry  hot  air  treatment.  The  pain  in  the  affected 
hand  and  arm  was  relieved  during  this  procedure,  and  did 
not  return  again  sufficiently  to  demand  another  local  treatment, 
and,  to  make  a  long  story  short,  the  affected  members  pro- 
gressed to  a  complete  and  fairly  steady  recovery  during  the 
next  four  days,'  at  which  time  the  temperature  reached  the 
normal  point  and  stayed  there. 

The  next  two  cases  were  reported  by  me  in  the  Medical 
News,  issue  of  July  n,  1903,  and  illustrate  the  second  and 
third  types  of  infection,  respectively. 

Case  II. 

Mr.  G.  P.  H.,  thirty-two  years  old,  was  brought  to  the  sani- 
tarium March  2,  1901,  by  Dr.  A.  S.  Cheney,  of  New  Haven. 
Four  days  previously  he  had  cut  his  hand  with  a  dirty  jack- 
knife.  The  usual  evidences  of  infection  duly  appeared,  and 
when  he  entered  he  was  in  a  condition  of  profound  prostration, 
with  a  temperature  of  103.4°  F.,  respiration  28,  but  the  pulse 
was  only  86.  Hand  and  arm  were  considerably  swollen.  Lym- 
phatic glands  about  the  elbow  and  in  the  axilla  were  irregularly 
enlarged,  those  in  the  latter  situation  to  about  the  size  appar- 
ently of  an  English  walnut.  He  was  in  constant,  severe  pain. 
The  presence  of  deeply-located  suppuration  seemed  probable, 


1 24  Therapeutics  of  Dry  Hot  A  ir. 

but  was  not  positively  demonstrable.  He  had  been  brought  in 
with  the  intention  of  operating  the  next  day.  It  was  finally  de- 
cided, however,  to  treat  him  with  dry  hot  air  first,  holding 
operative  interference  in  reserve. 

At  noon  of  the  day  following  his  admission  he  was  given  a 
body  dry  hot  air  treatment  at  340°  F.  Perspiration  was  pro- 
fuse, the  pain  was  relieved  entirely  before  the  conclusion  of 
the  treatment,  and  he  had  a  quiet,  refreshing  sleep  after  he  had 
been  removed  to  his  bed.  The  evening  temperature  was  102.5° 
F.,  as  against  103.4°  F.  on  the  previous  day. 

Next  morning,  at  eight  o'clock,  his  temperature  was  99.9°  F., 
pulse  84.  The  patient  had  slept  several  hours  during  the  night. 
The  pain  had  not  returned  to  any  great  degree,  and  the  prostra- 
tion and  nervous  symptoms  were  greatly  lessened.  The  swell- 
ing in  the  hand  and  arm  were  less,  as  was  also  the  enlargement 
of  the  glands  in  the  axilla.  He  was  given  another  body  treat- 
ment at  noon  at  350°  F.  His  temperature  was  101.8°  F.,  pulse 
80,  as  against  102.5°  F.  and  94  respectively  the  preceding 
evening. 

Treatment  was  administered  again  late  in  the  afternoon. 
Morning  temperature  the  next  day  was  99°  F.,  pulse  78. 
Patient  had  slept  at  intervals  during  the  night  and  during  the 
day,  resting  quietly.  That  evening  his  temperature  was  100.4° 
F.,  pulse  76.  Pain  and  swelling  had  entirely  gone  out  of  the 
arm,  but  the  axillary  enlargement  persisted,  as  did  also  a  con- 
siderable amount  of  pain  in  this  region. 

The  following  day,  March  7,  his  morning  temperature  was 
99.4°  F.,  pulse  76.  In  the  afternoon  he  was  given  a  body  dry 
hot  air  treatment  at  350°  F.,  and  the  next  day  his  temperature 
in  the  morning  was  99°  F.,  pulse  70.  In  the  evening  the  tem- 
perature rose  to  100.6°  F.,  with  the  pulse  averaging  88. 

At  this  time  palpation  of  the  axillary  enlargement  demon- 
strated the  presence  of  pus,  and  it  was  decided  to  open  the 
axilla  the  next  day,  which  was  done  at  four  o'clock  in  the 
afternoon,  Dr.  Cheney  operating.  Upon  incision,  a  large  quan- 
tity of  fluid  pus  was  evacuated  and  a  pocket  was  discovered 
running  up  under  the  clavicle  for  a  distance  of  about  three 
inches,  of  a  diameter  sufficient  to  admit  of  exploration  with  the 
forefinger,  but  no  glands  outside  of  it  were  involved  in  the 
infective  process.  It  will  be  observed  that  this  is  a  very  differ- 
ent picture  from  that  usually  encountered  under  these  condi- 
tions, where  the  contents  of  the  abscess  cavity  consist  of  pus 
with  a  plentiful  admixture  of  cheesy  detritus,  which  it  is  not 
at  all  easy  to  remove  in  a  thorough  manner,  and  where  gland 
after  gland  is  found  to  be  infected,  necessitating  a  vast  amount 
of  dissection,  in  order  that  the  extirpation  shall  be  complete. 


Local  Septic  Infection,  125 

The  abscess  cavity  was  curetted  out  and  the  subsequent 
progress  of  the  case  towards  recovery  was  rapid,  satisfactory, 
and  uneventful.  On  March  13  the  body  temperature  returned 
permanently  to  the  normal  point,  and  he  was  discharged  on 
March  23,  just  three  weeks  after  his  admission,  entirely  re- 
covered from  an  attack  of  septic  infection  which  was  very 
evidently  seriously  threatening  his  life  when  he  entered. 

This  case  illustrates  the  necessity  of  combining  operative 
interference  with  dry  hot  air  treatments  in  those  cases  where 
such  structures  as  lymphatic  glands  have  become  diseased  to 
such  an  extent  that  disintegration  is  inevitable,  or  when  pus 
accumulations  are  present.  The  immediate  improvement  in 
the  patient's  general  condition  after  the  first  dry  hot  air  treat- 
ment, together  with  the  strenuous  localization  of  the  inflam- 
matory process  in  the  axilla,  illustrate  respectively  the  happy 
influence  of  this  measure  in  lessening  general  systemic  tox- 
aemia, and  in  preventing  the  spread  of  the  infection  from  struc- 
ture to  structure,  through  its  power  of  increasing  the  physio- 
logical resistance  of  the  cells  composing  the  threatened  areas. 

Case  HI. 

Mr.  A.  W.  A.,  aged  fifty-one  years,  was  admitted  to  the  New 
York  Hospital  on  the  morning  of  January  8,  1902,  with  a 
traumatic  amputation  of  the  left  foot  at  the  ankle,  sustained  in 
a  railroad  accident.  The  crushed  member  was  attached  to  the 
leg  merely  by  the  lacerated  posterior  tendons,  and  the  patient, 
of  course,  was  suffering  considerably  from  shock. 

Amputation  of  the  lower  third  of  the  leg  was  done  by  Dr. 
Francis  Marcoe  that  afternoon.  Septic  infection,  however,  de- 
clared itself  three  days  after  the  injury.  On  January  12  it  was 
noticed  that  the  knee  was  swollen;  on  January  15  pus  began 
to  discharge  from  the  wound,  and  in  spite  of  the  utmost  care 
the  condition  increased  until  January  23,  fifteen  days  after  the 
original  injury.  At  this  time  the  leg  up  to  the  knee,  and  some- 
what above  this  joint,  was  enormously  swollen,  the  tissues  of 
the  stump  were  sloughing  in  places,  and  the  patient's  general 
condition  was  one  of  extreme  prostration.  In  short,  he  pre- 
sented a  typical  picture  of  the  severest  form  of  blood-poisoning, 
except  that  streptococci  had  not  been  found  in  his  blood. 

It  was  decided  to  amputate  the  infected  member  above  the 
knee  as  a  forlorn  hope.  This  was  done  by  Dr.  Frank  Hartley 
on  the  evening  of  January  23,  at  the  middle  of  the  thigh. 


1 26  Therapeutics  of  Dry  Hot  A  ir. 

Patient  rallied  very  well   from  the  operation,  and  the  next 
morning  was  given  a  body  dry  hot  air  treatment. 

During  the  time  intervening  between  January  24,  the  day  of 
the  second  operation  and  March  8,  the  day  of  his  discharge 
from  the  hospital,  the  patient  received  thirteen  body  treatments, 
the  greater  number  of  which,  of  course,  were  given  during 
the  two  weeks  immediately  succeeding  the  amputation  of  the 
thigh.  His  general  condition  began  to  show  slight  evidences 
of  benefit  at  once  in  the  way  of  increased  comfort,  ability  to 
sleep,  and  improvement  in  the  vital  signs,  and  he  continued 
to  gain  slowly  but  steadily  until  by  February  5  his  improvement 
had  become  so  manifest  as  to  justify  a  prognosis  of  recovery 
with  a  moderate  degree  of  certainty.  From  this  date  on  his 
improvement  was  entirely  satisfactory ;  to-day  his  general  con- 
dition is  better  than  it  has  ever  been  in  his  life  before,  and  he 
weighs  more  without  his  leg  than  he  ever  did  with  it. 

In  order  to  indicate  the  gravity  of  the  case,  I  will  say  here 
that  it  was  the  unanimous  opinion  of  the  physicians  who  saw 
him  that  neither  the  operation  or  any  other  ordinary  therapeu- 
tical measure  would  save  the  patient's  life.  The  fact,  also,  that 
slight  evidences  of  tissue  disintegration  appeared  in  the  wound 
three  days  after  the  second  operation,  is  indicative  of  the  fact 
that  the  operation  and  therapeutical  measures  other  than  dry 
hot  air  would  not  have  sufficed  to  secure  a  successful  termina- 
tion. 

As  far  as  I  know,  this  agent  has  never  been  called  upon 
to  influence  a  case  of  septic  infection  in  which  streptococci  were 
present  in  the  general  blood  circulation,  or  a  case  of  puerperal 
sepsis,  but  its  physiological  action,  and  what  is  known  already 
of  its  clinical  possibilities,  indicate  that  it  would  be  of  assist- 
ance in  even  these  ordinarily  desperate  conditions. 

TREATMENT. 

Local  Dry  Hot  Air  Application. — With  cases  belonging 
in  the  first-mentioned  category,  local  treatment  of  the  affected 
limb  is  usually  sufficient  to  effect  a  cure.  The  technique  does 
not  differ  from  that  usual  to  the  local  treatment,  and  the  tem- 
perature should  be  run  up  to  300°  or  400°  F.,  according  to  the 
tolerance  of  the  patient. 

In  cases  of  the  second  and  third  classes,  the  local  treatment 


Local  Septic  Infection.  1 27 

is  rarely  indicated  except  to  relieve  pain  or  to  hasten  sluggish 
healing  processes,  because,  as  before  stated,  the  menacing 
lesions  are  too  deeply  located  to  render  possible  its  effective 
application. 

General  Dry  Hot  Air  Application. — This  measure  is  not 
called  for  in  cases  of  the  first  class,  unless  considerable  general 
toxaemia  is  present,  but  in  cases  of  the  second  and  third  classes 
it  is  the  remedy  par  excellence. 

The  technique  is  that  usual  to  this  treatment,  except  that  we 
cannot  use  the  temperature  of  the  patient  as  a  guide  to  the 
duration  and  intensity  of  the  application,  because  it  is  usually 
considerably  elevated  when  the  patient  is  placed  in  the  appa- 
ratus. The  pulse  also  is  not  entirely  reliable  as  a  guide.  We 
have  to  be  governed  more  by  the  effect  upon  the  organism 
as  a  whole,  and  the  instinct  which  is  the  result  of  experience 
is  most  valuable  in  this  connection.  In  general,  however,  it  may 
be  said  that  the  treatment  should  last  not  less  than  twenty 
minutes,  and  that  the  temperature  required  will  vary  from 
250°  F.  to  350°  F.  The  response  on  the  part  of  each  individual 
patient  at  each  seance  will  govern  both  intensity  of  the  heat  and 
duration  of  the  application.  As  a  rule,  it  will  not  be  wise  to 
push  the  pulse  above  140  beats  per  minute,  and  the  symptoms 
noted  under  "  Technique  of  the  Body  Treatment,"  as  indicating 
excessive  stimulation,  should  be  carefully  avoided. 

Usually  the  first  indication  that  the  toxaemia  is  diminishing 
is  a  lessening  of  the  nervous  erythism,  which  becomes  manifest 
immediately  after,  and  sometimes  before  the  conclusion  of  the 
first  treatment,  when  the  patient  frequently  falls  into  a  refresh- 
ing sleep  lasting  from  one  to  several  hours. 

The  augmented  functional  vigor  of  the  deep  spinal  sympa- 
thetic nerve  centers  is  evidenced  before  the  patient  leaves  the 
apparatus  by  the  improved  character  of  the  pulse,  within  four 
or  five  hours  by  a  fall  in  the  body  temperature,  and  within 
twenty-four  hours  usually,  the  re-invigoration  of  the  trophic 
functions  is  manifested  by  a  marked  lessening  or  a  sharp  locali- 
zation of  the  local  inflammatory  phenomena. 

A  point  deserving  of  consideration  when  treating  these 
cases  is  that  when  a  patient  has  been  severely  septic  for  several 


128  Therapeutics  of  Dry  Hot  Air. 

days,  as  many  have  been  before  they  are  given  the  benefit 
of  dry  hot  air,  his  nervous  system  exhibits  the  irritability  of 
depression  to  a  marked  degree,  and  he  is  not  able  to  endure  the 
body  treatment  for  half  an  hour.  Under  these  circumstances 
the  heat  should  he  run  up  quickly,  for  instance  to  300°  F.  in 
fifteen  minutes.  By  this  means  a  quick  and  effective  stimula- 
tion may  be  induced  before  the  patient's  endurance  is  exhausted, 
whereas,  if  the  temperature  ran  up  as  slowly  as  would  ordi- 
narily be  the  case,  it  would  not  be  possible  to  secure  the  neces- 
sary deep  reflex  response  without  forcing  the  length  of  treat- 
ment beyond  a  judicious  limit. 

Additional  Remedial  Measures. 

Diet. — The  management  of  the  ingesta  does  not  differ  in  any 
particular  from  that  ordinarily  indicated  in  this  condition. 

Drugs. — Medicines  are  useful  to  keep  the  bowels  open  and 
to  correct  digestive  derangements ;  magnesium  sulphate  for  the 
former  and  digestive  ferments,  with  small  doses  of  strychnia 
for  the  latter.  It  is,  however,  very  rarely  indeed  necessary  to 
give  them  to  relieve  pain  or  for  stimulation,  after  the  adminis- 
tration of  dry  hot  air  is  begun. 

Operative  Interference. — The  aid  of  surgical  measures 
should  be  promptly  enlisted  whenever  glands  or  other  struc- 
tures have  become  diseased  beyond  the  possibility  of  repair,  or 
so  that  their  further  preservation  involves  serious  menace  to 
the  patient,  and  when  suppuration  has  become  established.  Dry 
hot  air  will  not  remove  moribund  tissues  or  pus.  Its  great  func- 
tions in  suppurative  cases  are  to  relieve  pain,  prevent  the  in- 
fection from  spreading  to  contiguous  structures,  lessen  the  sys- 
temic toxaemia,  and  hasten  repair  of  damaged  structures,  and 
these  it  accomplishes  nobly  and  well. 

It  is  not  necessary  to  protect  operation  wounds  during  dry 
hot  air  applications  with  more  wrappings  than  the  rest  of  the 
body,  and  the  proper  surgical  dressings  will  ordinarily  be 
sufficient.  The  healing  of  such  wounds  is  hastened  by  the 
treatments. 

Electricity. — Electricity  never  enters  the  therapeutical  prob- 
lem when  dry  hot  air  is  available,  except  to  assist  in  healing 


Local  Septic  Infection.  129 

sluggish  sinuses.  Here  the  negative  pole  of  the  galvanic 
battery,  applied  to  the  offending  granulations  through  a  bare 
metal  electrode,  using  from  three  to  five  milliamperes  of  cur- 
rent for  five  or  ten  minutes,  will  do  more  execution  than  any 
other  measure  with  which  I  am  familiar.  Care  should  be 
taken  not  to  use  enough  current  to  cauterize ;  the  good  results 
are  effected  by  electrolysis,  not  by  destruction. 


CHAPTER   VII. 
PNEUMONIA. 

Modifications  of  Clinical  Conditions 
producible  with  Dry  Hot  Air. 

Local  Application. 

First,  immediate  relief  of  pleuritic  pain  lasting  for  from  one 
to  eight  hours,  which  is  conducive  to  the  patient's  comfort, 
hence  conservative  of  his  vital  energy. 

Second,  relief  of  that  proportion  of  the  cough  and  respira- 
tory embarrassment  due  to  the  pleurisy. 

Third,  a  marked  inhibitive  influence  exerted  upon  the  growth 
of  the  pneumococcus  colonies  in  the  area  of  consolidation 
whereby  the  circulation  and  nerve  centers  are  relieved  from 
a  large  proportion  of  the  toxin  depression  and  irritation  which 
result  from  their  unimpeded  development,  and  a  decrease  of 
febrile  movement  of  from  half  a  degree  to  one  degree  Fahren- 
heit is  usually  secured  within  twelve  hours. 

Fourth,  rapid  absorption  of  the  exudate  to  such  an  extent 
that  the  physical  signs  of  consolidation  entirely  disappear  in 
from  one  to  four  days  after  the  first  application,  which  dimin- 
ishes the  danger  of  cardiac  distention  and  removes  the  symp- 
toms caused  by  encroachment  upon  functionable  respiratory 
areas. 

General  Application. 

First,  a  reflex  stimulation  of  the  vital  powers  unparalleled 
in  extent  and  profundity  by  that  producible  with  any  other 
measure,  and  which  is  evidenced  by  marked  improvement  in 
the  circulatory  function  before  the  patient  leaves  the  apparatus. 

Second,  relief  of  the  pulmonary  blood-vessels  by  a  dilatation 
of  the  peripheral  circulation,  the  extent  of  which  again  is  un- 
surpassed, if  not  unequaled,  by  that  obtainable  with  any  other 
measure  now  known. 

130 


Pneumonia.  J3l 

Third,  elimination  of  toxins  already  formed  and  in  the 
blood,  to  an  extent  and  with  a  rapidity  unattainable  by  any 
other  means. 

Fourth,  reduction  of  excessive  body  temperature  amounting 
to  from  half  a  degree  to  a  degree  and  a  half  Fahrenheit,  and 
marked  improvement  in  the  general  symptomatic  phenomena, 
within  five  hours  after  administration. 

The  writer  was  first  led  to  use  this  agent  in  pneumonia  by 
his  observation  of  its  kindly  influence  upon  a  case  of  peritonitis, 
and  the  first  case  of  pneumonia  so  treated  was  reported  in  the 
New  York  Medical  Journal  for  October  2,  1899.  The  agent 
was  applied  to  this  case  more  in  the  hope  of  relieving  the 
pleuritic  pain  than  of  influencing  the  pneumonic  process,  but  to 
the  writer's  surprise  and  gratification  the  general  and  local 
pneumonic  symptoms  were  mitigated  as  well  as  the  pleurisy, 
and  in  subsequent  cases  it  has  confirmed  its  claims  to  respect 
then  put  forward  as  a  therapeutical  measure  with  which  to 
attack  this  infection.  At  the  present  time  the  writer  believes 
that  judiciously  and  thoroughly  (I  desire  to  emphasize  these 
two  adjectives)  applied  dry  hot  air  treatments  constitute  one 
of  the  most  efficient  means  now  known  for  combating  this 
disease. 

RATIONALE    OF    THERMOTHERAPY. 

A  brief  consideration  of  the  etiology  and  pathology  of  the 
disease  is  necessary  in  order  that  the  rationale  of  its  power 
to  produce  these  results  may  be  comprehended,  and  the  con- 
ception of  the  same  put  forward  by  Dr.  Andrew  H.  Smith,  of 
New  York,  N.  Y.,  carries  with  it  more  conviction  than  any 
other  of  which  I  am  cognizant.  In  addition,  it  offers  plausible 
explanation  of  the  action  of  dry  hot  air  in  this  disease.  Briefly, 
Professor  Smith's  explanation  is  as  follows: 

Etiology  and  Pathology. — The  primary  etiological  element 
consists  of  the  development  of  cultures  of  pneumococci  in  the 
pulmonary  alveoli,  from  which  toxins  are  absorbed  into  the 
circulation,  and  produce  the  general  systemic  disturbance,  in- 
cluding "  heart  failure."  The  pabulum  for  the  growth  of  the 
micro-organisms  is  constituted  by  the  fibrinous  exudate  which 


132  Therapeutics  of.  Dry  Hot  Air. 

pours  into  the  alveoli  because  of  the  irritation  of  their  walls  by 
the  presence  of  the  germ  colonies. 

That  it  is  not  an  inflammation  of  the  lung  tissue  in  the 
ordinary  sense  is  indicated  by  the  fact  that  any  such  inflam- 
matory process  of  a  sufficient  intensity  to  produce  the  clinical 
phenomena  of  pneumonia  would  very  surely  be  followed  by 
irreparable  destruction  of  large  masses  of  pulmonary  tissue, 
whereas,  in  this  disease  after  the  process  has  subsided,  the  in- 
tegrity of  the  lung  structure  is  usually  entirely  restored;  and 
that  autopsical  findings  demonstrate  that  the  bronchial  or 
nutrient  circulation  is  very  rarely  involved  at  all,  but  that  when 
it  is,  gangrene  of  the  areas  strangulated  is  very  sure  to  result. 

This  means  that  obstruction  of  the  pulmonary  or  functional 
circulation  by  the  exudate,  and  reflex  pneumogastric  irritation 
due  to  the  same  cause,  are  probably  responsible  for  the  greater 
part  of  the  respiratory,  and  much  of  the  cardiac  disturbance  ob- 
served in  uncomplicated  pneumonia. 

The  life  of  the  pneumococcus  in  artificial  cultures  is  from  ten 
to  twelve  days,  and  it  is  one  of  the  most  sensitive  of  all  bacteria 
to  changes  in  the  conditions  of  its  pabulum  as  regards  tempera- 
ture, reaction,  etc.  It  grows  best  in  faintly  alkaline  media,  and 
a  marked  acidity  will  entirely  inhibit  its  development,  hence 
the  fibrinous  exudate  in  the  air-cells  constitutes  an  ideal  cul- 
ture medium. 

During  the  process  of  hepatization  pneumic  acid  forms,  and 
when  the  saturation  of  the  exudate  reaches  a  sufficiently  high 
point,  the  further  development  of  new  colonies  of  germs  is 
thereby  inhibited.  It  is  by  reason  of  this  fact,  together  with 
the  exhaustion  of  the  culture  medium  (exuded  fibrin),  and  the 
possible  formation  at  a  certain  stage  of  an  antitoxin,  that  the 
termination  by  crisis  obtains.  Modifications  of  these  conditions 
produce  termination  by  lysis. 

Professor  Smith  presented  the  subject  in  detail  in  an  address 
to  the  New  York  Academy  of  Medicine,  which  was  published 
in  the  Medical  News  for  December  18,  1899.  During  the 
course  of  this  address  he  states  his  "  views  as  to  the  sequence 
of  events  taking  place  in  an  attack  of  pneumonia,"  to  be  as 
follow : 


Pneumonia.  133 

"  i.  The  occurrence  of  some  cause  of  depression,  either  local 
or  general,  which  favors  the  germination  of  pneumococci,  al- 
ready present  in  some  one  of  the  smaller  tubes. 

"  2.  The  formation  of  a  colony  that  spreads  until  it  reaches 
the  group  of  air-vessels  that  are  terminal  to  the  tube  in  ques- 
tion. 

"  3.  The  setting  up  of  an  irritation  in  these  vessels,  causing 
a  fibrinous  exudation,  an  emigration  of  leucocytes,  and  a 
diapedesis  of  red  cells  from  the  functional  capillaries. 

"  4.  The  formation  of  a  colony  of  pneumococci  in  the 
medium  afforded  by  this  exudate. 

"  5.  Arrest  of  the  blood  stream  in  the  functional  capillaries, 
followed  by  accumulation  of  free  pneumic  acid  in  the  paren- 
chyma of  the  affected  area. 

"  6.  Overflow  of  exudate  into  neighboring  lobules,  starting 
the  process  in  them  also. 

"  7.  Arrest  of  germ  growth  by  the  exhaustion  of  the  medium 
and  the  accumulation  of  free  acid  in  the  tissue  of  the  lung. 
Up  to  this  time  there  has  been  a  constant  formation  and  ab- 
sorption of  toxin. 

"  8.  Retrogressive  changes  in  the  exudate  preparatory  to  its 
removal  by  absorption. 

"  9.  Probably,  in  this  latter  process,  formation  of  an  anti- 
toxin principle. 

"  10.  Entire  removal  of  the  exudate,  and  restoration  of  the 
vesicle  to  its  normal  condition. 

"  ii.  Resumption  of  the  functional  capillary  circulation." 

The  points  to  be  borne  in  mind  in  considering  this  part  of 
our  subject,  then,  are  as  follow : 

First,  the  diplococcus  of  Frankel  is  an  organism  exquisitely 
sensitive  to  changes  in  the  temperature  and  character  of  its 
pabulum,  and  its  life  period  in  laboratory  cultures  is  from  ten 
to  twelve  days. 

Second,  we  have  a  condition  here  which  is  closely  analogous 
to  that  which  obtains  when  cultures  of  the  organism  are  grown 
in  the  laboratory ;  the  walls  of  the  pulmonary  alveoli  acting 
as  test-tubes  and  the  exuded  fibrin  as  culture  medium,  to  appro- 
priate another  of  Professor  Smith's  apt  expressions. 


1 34  Therapeutics  of  Dry  Hot  A  ir, 

Third,  when  consolidation  has  taken  place,  the  layers  of  the 
pleurae  being  in  apposition,  and  even  sometimes  absolutely  ad- 
herent, from  fibrin  exudation,  we  have  practically  a  solid  tissue 
from  the  integument  to  the  inner  limit  of  the  consolidation,  ex- 
cept in  those  comparatively  infrequent  cases  where  the  con- 
solidation is  central  exclusively. 

Fourth,  the  general  systemic  phenomena,  including  "  heart- 
failure,"  are  due  to  the  influence  upon  nerve  centers,  muscles, 
and  glandular  structures,  of  toxins  emanating  from  the  germ 
cultures  in  the  alveoli  and  absorbed  into  the  blood. 

Fifth,  the  most  virulent  toxins  are  produced  where  the 
colonies  are  youngest,  hence  come  from  the  periphery  of  the 
affected  area  where  the  cultures  are  thinnest  and  spreading 
into  other  alveoli. 

Sixth,  in  many  cases,  much  of  the  cough  and  a  considerable 
proportion  of  the  respiratory  acceleration,  are  due  to  reflex 
irritation  and  pain,  set  up  by  the  pleurisy  which  usually  accom- 
panies the  trouble.  A  bit  of  clinical  evidence  in  favor  of  this 
probability  is  that  local  dry  hot  air  applications  do  not  immedi- 
ately diminish  the  respiratory  acceleration  or  cough  much, 
unless  pleurisy  is  present. 

Seventh,  death  is  directly  due  either  to  paralysis  of  nerve 
centers  from  toxin  absorption,  or  paralysis  of  the  right  heart 
from  over-distention  of  the  ptomaine-impaired  viscus  precipi- 
tated by  massive  exudate. 

Therapeutic  Indications. — The  objects  of  treatment  may 
be  briefly  stated  as  follow : 

First,  to  secure  the  destruction  of  the  colonies  of  pneu- 
mococci  in  the  lung,  or,  failing  this,  as  profound  an  inhibition 
of  their  development  as  possible,  whereby  the  quantity  or 
virulence  of  toxins  introduced  into  the  general  circulation 
would  be  diminished. 

Second,  to  secure  as  rapid  and  profuse  an  elimination  of  the 
toxins  already  in  the  body  as  possible. 

Third,  to  secure  absorption  of  the  exudate  as  rapidly  as 
possible. 

Fourth,  to  relieve  pleuritic  pain  when  present. 

Fifth,  to  increase   the  patient's  vitality  and  metabolic  ac- 


Pneumonia.  135 

tivity,  whereby  his  physiological  resistance  and  recuperative 
capacity  will  be  augmented. 

Local  Application. — Now,  when  a  local  dry  hot  air  treat- 
ment is  administered  over  a  consolidated  lobe,  it  is  reasonable 
to  infer  that  the  heat  could  be  made  to  penetrate  in  some 
degree  nearly,  if  not  quite,  through  the  whole  of  the  affected 
area  by  conduction,  as  the  part  is  then  practically  a  solid  tissue, 
and  the  heat  is  applied  to  the  front  and  back,  as  well  as  the 
side  of  the  chest  over  the  affected  region. 

If  this  is  true,  then  the  temperature  of  the  pabulum  of  the 
invading  micro-organisms  could  be  raised,  and  one  of  the  most 
essential  conditions  of  their  well-being  disturbed.  We  have 
seen  that  it  is  only  in  the  absence  of  a  disturbance  of  these 
conditions  that  this  germ  is  able  to  grow  at  all,  hence  this 
result  would  very  certainly  exercise  an  inhibitory  influence 
upon  its  development,  from  which  would  result  a  lessening  of 
the  quantity  and  virulence  of  the  toxins  formed. 

As  the  general  symptomatic  phenomena  are  due  to  absorp- 
tion of  these  same  toxins,  any  influence  which  lessened  their 
quantity  or  virulence  would  also  lessen  the  intensity  of  the 
general  symptoms,  and  we  should  expect,  as  a  result  of  the 
application  of  such  an  influence,  a  drop  in  the  body  temperature 
and  a  considerable  amelioration  of  the  depression  of  the  nerve 
centers ;  and  bedside  experience  proves  this  deduction  to  be 
true. 

But  the  question  at  once  arises,  "  If  this  is  true  why  would 
it  not  be  possible  to  abort  pneumonia,  to  cut  the  attack  short 
at  once  with  the  local  dry  hot  air  treatment  ?  " 

We  have  seen  that  the  germ  c'olonies  tend  to  invade  other 
air-cells  and  bronchioles  by  spreading  from  the  periphery  of 
the  consolidated  area,  and  that  these  youngest,  peripheral 
colonies  give  rise  to  the  most  virulent  of  the  toxins.  Those 
air  cells  and  bronchioles,  which  have  been  newly  invaded,  are 
not  yet  consolidated,  hence  have  not  yet  become  solid  tissue, 
and  air  circulates  through  them.  It  would,  therefore,  be  im- 
possible to  raise  the  temperature  of  these  parts  very  markedly 
if  at  all,  and  the  inhibitory  influence  susceptible  of  induction 
in  the  fully  consolidated  portion  could  not  be  attained  here. 


1 36  Therapeutics  of  Dry  Hot  A  ir. 

These  colonies,  therefore,  would  continue  to  multiply  and 
spread  until  they  had  reached  the  end  of  their  normal  life 
period,  and  the  system  at  large  would  continue  to  feel  the 
effects  of  such  toxins  as  emanated  from  these  areas,  although 
relieved  from  those  formed  in  the  original  and  larger  focus. 

As  a  consequence,  we  should  expect  some  fever,  acceleration 
of  pulse  and  respiration,  general  prostration,  etc.,  to  continue 
until  the  natural  period  for  the  termination  of  the  attack  had 
arrived,  and  this  is  exactly  what  happens.  The  patient,  being 
relieved  from  a  large  degree  of  the  intoxication  from  the 
greater  bulk  of  the  infective  focus,  exhibits  a  marked  and  im- 
mediate improvement,  but  does  not  recover  entirely  until  the 
infection  has  reached  the  period  of  its  normal  defervescence. 

Further,  in  this  connection,  it  would  be  expected  that,  if  the 
dry  hot  air  applications  were  discontinued  too  soon,  the  germ 
colonies  at  the  periphery  of  the  original  focus  of  infection 
would  again  multiply,  so  as  to  produce  some  amount  of  consoli- 
dation and  an  increase  in  the  systemic  disturbance.  Bedside 
experience  also  confirms  this  expectation. 

A  final  logical  inference  would  be  that  central  pneumonia, 
where  a  layer  of  functionating  air-cells  interposed  between  the 
focus  of  the  infection  and  the  dry  hot  air  apparatus,  would  fail 
to  respond  to  the  treatment  as  well  as  the  ordinary  form 
where  the  consolidated  area  constitutes  a  practically  solid  tissue 
continuous  with  the  external  skin,  thus  facilitating  conduction 
of  the  heat;  and  experience  so  far  indicates  that  this  also  is 
true.  In  the  small  number  of  cases  of  this  variety  of  pneu- 
monia that  has  come  under  my  observation  since  I  have  been 
using  this  therapeutical  agent,  the  reaction  has  been  much  less 
satisfactory ;  but  even  here  that  benefit  was  derived  was  unmis- 
takable. 

There  is  another  possible  explanation  of  the  effect  of  local 
dry  hot  air  applications  upon  pneumonia,  viz.,  that  the  direct 
and  reflex  acceleration  of  metabolic  processes  in  and  about  the 
consolidation  results  in  the  immediate  production  of  an  acid 
reaction  in  the  exudate  whereby  the  development  of  the  germ 
colonies  would  also  be  inhibited.  As  has  been  stated,  the 
evolution  of  pneumic  acid  is  a  natural  phase  of  the  later  stages 


Pneumonia.  137 

of  the  phenomenon  of  consolidation,  and  the  logical  tendency 
of  thermo-therapeutical  applications  would  be  to  hasten  the 
natural  sequence  of  metabolic  events.  The  former  solution  of 
the  problem  appears  at  present  to  be  the  more  probable,  but 
this  one  deserves  consideration  in  this  connection. 

It  is  significant,  with  reference  to  the  foregoing,  that  Dr. 
Beverley  C.  Kinnear,  of  New  York  City,  used  heat  with  bene- 
ficial results  in  the  treatment  of  pneumonia,  in  the  form  of  hot- 
water  bags  or  flannels  wrung  out  of  hot  water,  continuously 
applied,  previous  to  1898.  His  paper  upon  this  subject  was 
published  in  the  Boston  Medical  and  Surgical  Journal  for 
December  2,  1897.  He  made  his  applications  over  the  dorsal 
sympathetic  ganglia,  and  believed  the  effect  to  be  due  to  reflex 
influence  exerted  upon  and  through  these  structures.  Is  it  not 
possible,  however,  that  the  benefit  was  due,  in  part,  at  least, 
to  a  greater  or  less  inhibition  of  germ  growth  through  the 
raising  of  the  temperature  of  the  adjacent  structures,  muscles, 
pleurae,  etc.,  and  through  those  of  portions  of  the  contiguous 
consolidation  ? 

The  application  of  cold  in  the  form  of  ice  packed  about  the 
chest  has  also  been  employed  with  benefit  in  this  disease.  This 
measure  would  unquestionably  exercise  a  certain  amount  of  ip- 
hibitory  influence  upon  the  growth  of  pneumococcus  colonies, 
by  lowering,  in  some  degree,  the  temperature  of  at  least  por- 
tions of  the  consolidated  area,  but  it  would  not  stimulate  ab- 
sorption or  metabolism;  on  the  contrary,  cold  retards  these 
processes,  hence  this  measure  would  not  be  expected  to  produce 
the  same  degree  of  beneficial  effect  as  intense  dry  heat.  The 
patient's  vitality,  as  represented  by  his  reactive  powers,  con- 
stitutes a  large  element  in  securing  a  favorable  effect  from 
cold  applications.  When  heat  is  employed,  this  factor  does  not 
enter  the  equation,  as  he  has  had  nothing  administered  that 
demands  reaction  for  the  development  of  its  benefits;  its 
favorable  influence  is  direct  and  inherent. 

An  incontrovertible  elucidation  of  the  exact  manner  in  which 
these  effects  of  hot  and  cold  local  applications  in  pneumonia 
are  brought  about  is  at  present  impossible,  nor  is  it  necessary 
for  our  present  purposes.  The  vital  point  is  that  they  are 


138  Therapeutics  of  Dry  Hot  Air. 

brought  about,  and  that  this  is  so  is  attested  by  a  large  number 
of  competent  clinical  observers. 

General  Application. — Occasionally  a  case  is  encountered 
where  the  patient's  excretory  organs  are  incapable  of  eliminat- 
ing the  toxins  with  sufficient  rapidity,  and  a  depression  of 
nerve  centers  develops  which  threatens  speedily  to  end  the 
scene  and  the  patient. 

This  condition  may  be  brought  about  by  defective  renal 
function,  a  low  condition  of  the  patient's  vital  powers  when 
the  infection  was  sustained,  or  a  particularly  virulent  type  of 
infection.  Whichever  the  cause,  the  local  treatment  is  ordina- 
rily useless,  because  it  could  not  possibly  influence  the  kidney 
to  any  degree  when  applied  to  the  lung ;  the  small  area  of  skin 
subjected  to  its  influence  does  not  contain  enough  nerve  end- 
ings to  make  possible  a  reflex  stimulation  of  the  spinal  centers 
profound  enough  to  overcome  a  general  debility  of  this  char- 
acter ;  and,  as  has  been  seen,  the  most  virulent  toxins  emanate 
from  the  youngest  colonies  of  germs,  which  are  so  placed  in 
the  periphery  of  the  area  of  consolidation  as  to  be  beyond  the 
penetrative  limit  of  the  local  application.  The  only  resource 
then  becomes  the  induction  of  profuse  and  rapid  elimination 
from  a  larger  area  of  the  skin,  a  rousing  of  the  kidneys  and 
lungs  to  increased  function,  and  a  strong  stimulation  of  the 
spinal  centers  which  are  being  overwhelmed,  and  the  body  dry 
hot  air  treatment  enters  the  arena.  As  will  be  seen  by  referring 
to  its  physiological  action,  it  possesses  the  power  to  accomplish 
all  of  these  objects  in  an  eminent  degree,  and  the  method  of  its 
application  will  be  described  in  a  subsequent  section. 

ILLUSTRATIVE   CASES. 

The  following  instance  exemplifies  very  well  the  effect  of  the 
local  application  upon  the  ordinary  case  of  pneumonia : 

Case  I. 

Mr.  G.  W.  P.,  age  thirty-four  years,  a  clergyman  by  occupa- 
tion. I  saw  the  patient  first  on  March  29,  1900,  at  9  A.  M.  He 
had  been  in  his  usual  health  until  the  preceding  evening,  when 
he  had  begun  to  feel  "  badly  all  over,"  and  had  noticed  a 
sharp  pain  under  his  left  nipple.  This  had  grown  worse  dur- 
ing the  night,  and  towards  morning  he  had  begun  to  cough 


Pneumonia.  139 

some,  which  increased  the  pain,  as  did  also  deep  respiration. 
Auscultation  and  percussion  elicited  nothing  abnormal.  His 
pulse  was  76  per  minute,  respiration  20,  temperature  98.6°  F. 
It  looked  like  developing  influenza,  and  the  patient  was  sent 
to  bed  and  an  anodyne  cough  mixture  prescribed. 

March  29,  7  p.  M.  The  cough  had  increased  during  the  day 
and  the  pain  under  the  nipple  was  now  harassing  in  the  ex- 
treme. Severe  headache  had  developed,  but  there  was  no  ex- 
pectoration. Pulse  was  100  per  minute,  respiration  48,  tem- 
perature 101.6°  F.  Physical  examination  discovered  a  few 
crepitant  rales  and  a  marked  pleural  creak,  but  no  dullness. 
I  made  a  diagnosis  of  commencing  pneumonia,  directed  that 
a  hot-water  bag  be  applied  over  the  site  of  the  pleurisy,  and 
that  five  grains  of  antikamnia  be  given  every  hour  until  the 
headache  was  relieved. 

.  March  29,  n  P.  M.  The  pain  had  lessened  somewhat  under 
the  influence  of  the  hot-water  bag  and  ten  grains  of  anti- 
kamnia, and  this  drug  was  then  discontinued.  Slight  dullness 
had  developed  over  the  lower  lobe  of  the  left  lung.  Pulse  was 
98,  respiration  48,  temperature  100.6°  F. 

March  30,  8  A.  M.  Patient  had  been  very  restless  during  the 
night,  and  had  slept  but  little.  Headache  and  pleuritic  pain 
had  increased  after  midnight,  and  were  now  again  extremely 
harassing.  He  was  expectorating  a  green  viscid  mucus,  which 
adhered  to  the  bottom  of  an  inverted  dish.  Pulse  was  100,  res- 
piration 42,  temperature  100.8°  F.  Dullness  was  now  marked 
over  lower  lobe  of  left  lung. 

Patient  was  greatly  prostrated,  and  his  pain,  frequently 
exacerbated  by  coughing,  was  increasing  his  prostration,  but 
I  hesitated  to  give  him  morphine  because  he  was  of  a  mark- 
edly neurotic  temperament,  and  I  also  feared  the  respiratory 
depression  so  frequently  dependent  upon  its  administration 
under  these  conditions.  I  decided  to  try  Baume  Analgesique, 
applied  over  the  pleurisy  with  a  hot-water  bag  over  it,  and 
directed  that  I  be  notified  if  no  amelioration  occurred  by  n 
o'clock  A.  M. 

I  was  so  notified,  and  decided  to  treat  the  consolidated  lobe 
with  dry  hot  air,  which  was  done  at  noon.  At  the  end  of  the 
treatment  the  pleuritic  pain  was  entirely  relieved,  except  when 
coughing  violently  or  upon  forced  respiration,  and  the  pulse 
had  dropped  to  96,  respiration  to  28.  During  the  morning 
the  sputum  had  become  blood-stained,  and  was  now  typically 
pneumonic. 

March  30,  8  p.  M.  The  pleuritic  pain  had  remained  in  abey- 
ance until  6  P.  M.,  but  had  been  very  severe  since.  Pulse  was 
loo,  respiration  56.  temperature  103°  F.  Dry  hot  air  was  again 


140  Therapeutics  of  Dry  Hot  Air. 

administered,  completely  relieving  the  pain  as  usual,  and  at  the 
end  of  the  treatment  the  pulse  was  94,  respiration  38.  I  left 
the  patient  resting  quietly. 

March  31,  9  A.  M.  He  had  continued  to  rest  comfortably 
until  2  A.  M.,  when  the  pleuritic  pain  had  begun  to  return,  and 
it  was  now  severe  again.  The  cough  had  greatly  lessened 
and  what  little  sputum  he  raised  was  rusty  and  very  tenacious. 
Pulse  was  96,  respiration  32,  temperature  102.2°  F.  The  dull- 
ness over  the  affected  lobe  was  markedly  less,  and  numerous 
coarse  rales  were  present.  Dry  hot  air  was  administered. 

March  31,  9  P.  M.  Patient  had  no  pleuritic  pain  during  the 
day,  but  at  8  p.  M.  it  had  returned  nearly  as  severely  as  before. 
Sputum  had  become  much  lighter  in  color  during  the  after- 
noon, and  was  much  less  tenacious.  Percussion  betrayed  only  a 
very  small  area  of  slight  dullness  over  the  affected  lobe,  and 
the  coarse  rales,  so  plentiful  in  the  morning,  were  disappear- 
ing. Pulse  was  100,  respiration  30,  but  had  dropped  to  28  at 
noon,  and  temperature  was  102.2°  F.  Dry  hot  air  was  admin- 
istered. 

About  fifteen  minutes  after  treatment  was  begun  the  pleu- 
ritic pain  disappeared,  and  patient  remarked  how  good  it  seemed 
to  be  free  from  it.  Shortly  afterward  he  exclaimed,  "  Oh,  how 
queer  I  feel !  "  I  asked  him  what  the  matter  was  and  he  tried 
to,  but  could  not  answer.  His  eyes  closed,  muscles  re- 
laxed, and  he  appeared  to  have  fainted.  I  felt  the  pulse ;  it 
was  very  soft,  and  the  respiration,  as  well  as  the  pulse,  had  be- 
come very  slow.  His  lips  were  blue  and  the  skin  on  the  face 
ashen.  I  immediately  removed  the  apparatus,  threw  the 
clothing  from  his  body,  and  had  the  nurse  fan  him  vigorously, 
while  I  opened  a  window  and  got  a  hypodermic  of  strychnia 
ready.  It  was  not  needed,  however,  as  in  a  minute  or  two  he 
revived,  opened  his  eyes,  and  his  pulse  and  respiration  re- 
sumed their  former  rate  and  character. 

By  evening  of  the  next  day,  April  i,  the  physical  signs  of 
consolidation  had  entirely  disappeared,  but  rales  were  still 
present,  and  they  persisted  in  some  degree  in  this  situation  for 
about  a  week. 

From  this  time  until  April  4  the  only  noteworthy  event  was 
an  acute  oedema  of  the  lungs,  lasting  about  six  hours,  which 
occurred  in  the  morning  of  April  2.  For  thirty-six  hours 
previously  the  patient  had  suffered  from  a  headache  which  had 
utterly  resisted  the  ordinary  analgetics,  and  which  had  become 
so  severe  that  I  was  obliged  to  resort  to  morphine  hypodermi- 
cally  during  the  night  of  April  i.  The  oedema  yielded  to  hypo- 
dermics of  strychnia  and  atropin  in  about  five  hours. 

Shortly  after  midnight  of  April  3  the  patient  became  slightly 


Pneumonia.  141 

delirious,  and  about  three  o'clock  in  the  morning  of  April  4 
pleuritic  pain  appeared  over  the  lower  lobe  of  the  right  lung. 
I  saw  him  at  8  A.  M.,  at  which  time  his  pulse  was  104,  respira- 
tion 38,  temperature  102.4°  F.  The  original  focus  of  infection 
in  the  lower  lobe  of  the  left  lung  was  in  a  satisfactory  condition, 
but  dullness  had  appeared  over  the  lower  lobe  of  the  right 
lung.  I  called  again  at  noon  and  found  that  the  dullness 
which  was  present  in  this  situation  in  the  morning  had  in- 
creased to  flatness,  and  the  sputum  was  bloody.  The  general 
condition  was  about  the  same  as  in  the  morning.  Dry  hot  air 
was  applied  over  the  lower  lobe  of  the  right  lung. 

April  4,  10  P.  M.  Patient  had  passed  a  very  comfortable 
afternoon.  Sputum  was  rusty.  Pulse  106,  respiration  36,  tem- 
perature IOI.63  F.  The  flatness  over  the  lower  lobe  of  the  right 
lung  had  decreased  to  dullness,  and  dry  hot  air  was  adminis- 
tered again  in  this  situation.  During  the  evening  Dr.  Rollin 
McNeil,  of  New  Haven,  saw  the  case  with  me  in  consultation, 
and  did  me  the  honor  to  observe  its  subsequent  course.  As  the 
patient  was  excessively  prostrated,  I  remained  with  him  dur- 
ing the  night. 

April  5,  8  A.  M.  Patient  had  developed  a  severe  lumbar 
myositis  in  both  sides,  but  especially  marked  in  the  right, 
which  had  first  manifested  itself  about  4  A.  M.  Spasms  in  the 
affected  muscles  were  frequent  and  painful,  and  extreme  ten- 
derness to  the  touch  was  present.  I  directed  that  mustard 
pastes  be  applied  over  the  affected  structures. 

April  5,  10  P.  M.  Muscular  spasm  and  pain  had  been  only 
slightly  relieved  by  the  sinapism,  and  the  patient  had  suffered 
considerably  from  them  during  the  day.  The  slightest  move- 
ment on  his  part,  or  manipulation  by  anyone  else,  would 
set  up  the  spasm.  Pulse  was  94,  respiration  34,  temperature 
100.2°  F.,  and  general  condition  much  the  same  as  in  the  morn- 
ing. Physical  examination  demonstrated  that  dullness  was 
present  only  in  spots  over  the  lower  lobe  of  the  right  lung,  and 
that  air  was  entering  pretty  freely  every  part  of  it. 

Dry  hot  air  was  administered  again  and  the  cloth  attach- 
ment was  carried  downward  and  backward  so  as  to  include  the 
inflamed  muscles.  At  the  end  of  the  treatment  the  patient 
could  cough,  respire  deeply,  and  move  about  in  the  bed,  and 
the  parts  could  be  manipulated  without  causing  spasm  or  pain. 
The  patient's  continued  extreme  prostration  decided  me  to 
remain  again  by  his  bedside  during  the  night. 

April  6,  8  A.  M.  Patient  had  passed  a  very  comfortable 
night,  sleeping  most  of  the  time.  Had  suffered  slightly  from 
muscular  spasm  about  2  A.  M.,  but  at  this  time  only  very  slight 
soreness  upon  manipulation  was  apparent,  and  patient  could 


142  Therapeutics  of  Dry  Hot  Air. 

move  freely  without  exciting  any  spasm  or  pain.  Sputum  had 
lost  its  rusty  character  and  was  opaque,  whitish,  and  somewhat 
frothy.  Pulse  92,  respiration  28,  temperature  99.2°  F.  Dull- 
ness had  disappeared  entirely  from  the  lobe  last  affected,  but 
some  rales  were  still  present  in  this  and  also  in  the  lower  left 
lobe. 

From  this  time  on  the  patient's  recovery  was  steady  and 
uneventful,  except  for  a  short,  but  pretty  sharp,  return  of  the 
myositis  on  April  8,  which  was  readily  controlled  by  dry  hot 
air  locally.  The  temperature  returned  permanently  to  the 
normal  on  April  22,  with  a  pulse  of  76,  and  respiration  of  18, 
but  it  had  not  been  higher  than  99.2°  F.  after  April  4.  The 
extreme  prostration,  which  had  caused  me  so  much  anxiety  on 
April  5  and  6,  had  disappeared  rapidly  after  April  8,  and  the 
convalescence  was  entirely  satisfactory  in  every  respect. 

It  will  be  observed  that  in  this  case  the  administration  of  dry 
hot  air  was  followed  by  the  results  noted  below. 

First,  immediate  relief  of  the  pleuritic  pain,  which  relief 
lasted  for  several  hours  after  treatment. 

Second,  a  decrease  in  the  frequency  of  respiration,  probably 
due  to  relief  of  the  pleuritic  pain,  and  which  on  the  evening  of 
March  30  amounted  to  twelve  cycles  per  minute. 

Third,  lessening  of  the  cough. 

Fourth,  a  drop  in  the  body  temperature  amounting  to  from 
half  a  degree  to  one  degree,  F.  It  will  be  observed  that  after 
the  second  treatment  the  temperature  did  not  at  any  time  rise 
above  102.2°  F.  until  the  morning  of  April  4,  when  the  right 
lung  became  involved,  and  even  then  it  only  reached  102.4°  F., 
an  unusually  low  temperature  for  an  ordinarily  severe  case  of 
pneumonia. 

Fifth,  entire  disappearance  of  the  physical  signs  of  consoli- 
dation within  forty-eight  hours  after  the  first  treatment  was 
administered. 

It  also  exemplifies,  during  the  administration  of  the  treat- 
ment on  the  morning  of  March  31,  the  cardiac  disturbance 
that  sometimes  occurs  when  the  lower  lobe  of  the  left  lung  is 
being  treated. 

As  previously  stated,  when  profound  general  toxaemia  is 
present,  the  general  application  is  the  measure  to  be  employed, 
but  that  the  influence  of  the  local  application  upon  the  toxin- 


Pneumonia.  143 

producing  factors  at  the  site  of  infection  is,  in  rare  instances, 
sufficient  to  avert  a  fatal  termination  was  evidenced  by  a  case 
which  occurred  in  the  practice  of  Dr.  B.  S.  Lewis,  of  New 
Haven,  Conn. 

Case  II. 

The  patient,  a  woman,  about  fifty  years  of  age,  had  been 
suffering  from  pneumonia  in  the  lower  lobe  of  the  right  lung 
for  several  days  and  had  become  comatose  from  toxaemia  dur- 
ing the  late  afternoon  of  May  4,  1900. 

Dr.  Lewis  called  Dr.  Rollin  McNeil  in  consultation  upon  the 
case ;  they  agreed  that  no  ordinary  therapeutical  measure 
offered  any  hope  of  saving  the  patient's  life,  and  invited  me  to 
administer  dry  hot  air. 

I  repaired  to  the  patient's  bedside  at  once,  in  company  with 
the  gentlemen  just  mentioned,  and  administered  the  first  treat- 
ment at  ii  o'clock,  P.  M.  At  this  time  the  patient  could  not  be 
aroused,  subsultus  tendinum  was  present,  her  pulse  was  130, 
weak,  compressible,  and  thready,  respiration  33,  and  she  was 
evidently  failing  rapidly ;  no  pleurisy  was  or  had  been  present. 
The  pulse  improved  before  the  treatment  was  concluded,  and 
shortly  afterward  the  nervous  symptoms  decreased,  but  the 
respiratory  acceleration  showed  no  sign  of  abatement  for  sev- 
eral hours,  probably  because  no  portion  of  it  was  due  to 
pleurisy.  When  we  called  to  treat  her  again  the  next  morning 
she  was  conscious,  the  pulse  and  other  symptoms  had  continued 
to  improve,  and  she  went  on  to  convalescence  and  complete 
recovery. 

Other  cases  in  which  I  have  relied  upon  the  local  application 
to  overcome  profound  general  toxaemia,  however,  have  died, 
and  I  do  not  now  consider  it  justifiable  to  postpone  the  body 
treatment  under  these  conditions.  One  of  the  fatal  cases  just 
referred  to,  occurring  in  the  practice  of  Dr.  Walter  C.  Skiff,  of 
New  Haven,  Conn.,  was  of  particular  interest  because  of  the 
fact  that  the  physical  signs  of  consolidation  had  almost  entirely 
disappeared  eighteen  hours  after  the  agent  was  first  applied, 
yet  the  patient  died  in  a  few  hours  just  the  same ;  a  bit  of  evi- 
dence tending  to  confirm  the  hypothesis  that  the  most  virulent 
of  the  toxins  emanate  from  the  colonies  of  pneumococci  at  the 
periphery  of  the  region  of  infection,  and  which  are  beyond  the 
reach  of  the  inhibitive  influence  of  the  local  application,  as  de- 
scribed in  a  preceding  section. 


144  Therapeutics  of  Dry  Hot  Air. 

TREATMENT. 

Local  Dry  Hot  Air  Application. — The  local  application  of 
this  agent  is,  in  many  cases,  the  only  thermo-therapeutical 
measure  required  in  pneumonia,  and  the  appropriate  technique 
is  as  follows : 

A  piece  of  cheap  Turkish  toweling,  four  or  five  feet  long  and 
eighteen  or  twenty  inches  wide,  is  folded  twice,  so  as  to  make 
three  thicknesses,  and  applied  closely  against  the  skin  over  the 
affected  portion  of  the  lung.  This  is  held  in  place  by  two  or 
three  pieces  of  webbing  one  inch  in  width,  supplied  with  buckles 
at  one  end,  and  long  enough  to  pass  clear  around  the  body. 
The  patient  is  then  brought  close  to  the  edge  of  the  bed  and 
supported  by  pillows  in  such  a  way  that  the  apparatus  can  be 
attached  directly  over  the  area  to  be  treated. 

The  heat  should  be  run  up  to  from  275°  F.  to  350°  F., 
according  to  the  patient's  tolerance,  and  the  duration  of  the 
treatment  should  be  from  half  an  hour  to  an  hour.  Victims  of 
this  disease  find  it  extremely  irksome  to  lie  in  one  position 
with  the  affected  lung  uppermost,  for  an  hour,  but  the  treat- 
ment'should  be  continued  for  this  length  of  time  if  it  can  be 
done  without  provoking  undue  exhaustion,  and  judgment  and 
experience  must  govern  on  this  point.  Treatments  of  less  than 
half  an  hour  are  of  little,  if  any,  use. 

When  treating  the  lower  lobe  of  the  left  lung,  it  should  be 
borne  in  mind  that  acute  dilatation  of  the  heart  is  sometimes 
induced,  either  by  reflex  influence  or  conduction  of  the  heat 
to  the  organ  through  the  area  of  consolidation,  and  the  pulse 
and  respiration  should  be  constantly  watched.  If  untoward 
symptoms  appear,  the  apparatus  and  wrappings  should  be  im- 
mediately removed,  and  the  patient's  body  exposed  and  fanned. 
Usually  this  will  take  care  of  the  condition  in  a  few  seconds, 
when  treatment  may  be  resumed.  If  the  patient  does  not 
revive  at  once,  towels  wet  in  cold  water  should  be  slapped 
over  the  chest  and  abdomen,  and  strychnia  injected  hypoder- 
matically. 

After-Care. — When  the  treatment  has  been  completed,  the 
capillary  area  which  has  been  subjected  to  its  influence  will 


0, 

!H 
O 

be 


a. 
a, 
«J 


Pneumonia.  147 

be  found  to  have  become  deeply  injected  and  covered  with  pro- 
fuse perspiration.  This  secretion  will  also  usually  be  in  evi- 
dence to  some  extent  on  other  parts  of  the  body.  It  may  be 
removed  with  a  dry  towel,  the  area  treated  wrapped  in  one 
thickness  of  flannel,  and  the  patient  made  comfortable  again  in 
bed,  but  no  other  after-applications  are  necessary.  It  will  be 
seen  that  poultices  and  pneumonia  jackets  are  entirely  uncalled 
for  when  dry  hot  air  is  obtainable,  hence  the  patient  and  his 
attendants  are  spared  the  exposure  and  discomfort  contingent 
upon  their  use. 

The  application  should  ordinarily  be  repeated  every  twelve 
hours  for  the  first  two  days,  and  once  daily  thereafter  until 
convalescence  is  established. 

General  Application. — The  patient  is  prepared  for  treatment 
in  the  usual  way  and  placed  in  the  apparatus,  and  the  heat  is 
run  up  as  rapidly  as  possible  to  275°  F.  or  300°  F.  If  perspira- 
tion or  marked  flushing  of  the  face  is  not  induced  by  this  tem- 
perature, the  same  should  be  increased  until  it  is,  or  until  the 
patient's  tolerance  is  reached.  The  treatment  should  last  from 
twenty  minutes  to  three-quarters  of  an  hour,  according  to  the 
effect  produced. 

As  the  body  temperature  of  the  patient  is  usually  already 
high  when  he  enters  the  apparatus  under  these  conditions,  it  is 
useless  as  a  guide  to  the  duration  of  the  seance,  and  the  pulse 
and  general  effects  must  be  relied  upon  for  guidance;  another 
situation  where  good  judgment  and  experience  are  friends  in 
need  and  in  deed.  In  a  general  way,  however,  it  may  be  said 
that  the  pulse  should  not  be  accelerated  beyond  140  beats  per 
minute,  and  that  when  sedation  of  the  nervous  system  or  dila- 
tation of  the  capillary  circulation — as  evidenced  by  decided 
flushing  of  the  face  or  general  perspiration — has  been  induced, 
it  is  time  to  stop.  Over-stimulation  means  exhaustion,  which 
should  be  avoided,  and  a  patient  in  the  extremity  we  are  con- 
sidering is  especially  susceptible  to  its  induction. 

The  after-care  does  not  differ  from  that  of  the  body  treat- 
ment in  general.  The  beneficial  influence  of  the  treatment 
upon  the  heart  and  nervous  system  is  frequently  apparent  while 
the  patient  is  still  in  the  apparatus,  and  it  lasts  from  twelve  to 


148  Therapeutics  of  Dry  Hot  Air. 

twenty-four  hours  usually.     The  application  may  be  repeated 
when  the  patient  begins  to  fail  again. 

Heart  Failure. — This  symptom  is  sufficiently  important  to 
merit  brief  special  mention  in  this  connection.  It  is  due  either 
to  massive  exudate  or  systemic  toxaemia,  or  a  combination  of 
both.  Massive  exudate  will  usually  yield  to  the  influence  of  the 
local  treatments  with  sufficient  readiness  to  save  the  patient,  but 
these  applications  are  not  effective  in  relieving  the  symptom 
when  due  to  systemic  toxaemia.  The  body  treatment  only 
is  efficient  here,  and  in  view  of  the  fact  that  the  patients 
almost  always  die  under  all  other  methods  of  treatment  when 
reduced  to  this  extremity,  it  is  justifiable  to  move  them  in  an 
ambulance  from  their  homes  to  a  hospital  if  they  cannot  be 
gotten  to  a  body  apparatus  in  any  other  way.  As  the  treatment 
would  be  applied  immediately,  the  evil  result  of  any  ordinary 
exposure  sustained  during  the  journey  would  be  remedied  at 
once,  and  the  patient  would  thereby  get  the  benefit  of  almost 
the  only  therapeutical  measure  that  offers  him  a  reasonable 
hope  of  recovery. 

Additional  Remedial   Measures. 

The  other  forms  of  physical  therapeutics  never  enter  the 
problem  of  the  treatment  of  this  disease  when  dry  hot  air 
is  obtainable,  but  medicines  are  important. 

Drugs. — Professor  A.  H.  Smith,  cited  previously,  advocates 
the  administration  of  drugs  which  are  excreted  largely  by  the 
lungs,  and  which  are  inherently  inimical  to  the  development  of 
the  pneumococcus.  The  extreme  sensitiveness  of  this  organism 
to  conditions  pervading  its  pabulum  renders  several  drugs  avail- 
able for  this  purpose,  among  which  may  be  mentioned  creosote 
carbonate,  the  salicylates,  large  single  doses  of  calomel,  and 
quinine ;  under  ordinary  circumstances  the  administration  of 
these  substances  is  not  deleterious  to  the  patient. 

The  two  first  mentioned  are  Professor  Smith's  choice,  the 
clinical  results  he  reports  are  excellent,  and  the  author  desires 
hereby  to  add  his  testimony  to  that  of  other  observers,  as  re- 
gards the  favorable  influence  of  creosote  carbonate,  at  least. 

The  weak  point  in  this  method  of  attacking  the  germs  is  that 


Pneumonia.  149 

some  stomachs,  kidneys,  and  nervous  systems  cannot  stand  the 
drugs  advocated  in  sufficient  quantities  to  render  possible  the 
induction  of  their  antiseptic  influence,  and  that  medicines  ex- 
creted in  this  manner  do  not  penetrate  to  the  germ  colonies 
deeply  located  in  the  consolidated  area.  They  do,  however, 
reach  the  youngest  of  the  colonies,  which  are  spreading  at  the 
periphery  of  the  consolidation  and  giving  rise  to  the  most 
virulent  of  the  toxins.  As  we  have  seen,  dry  hot  air  treat- 
ments exert  their  most  powerful  influence  upon  the  area  of 
consolidation,  hence,  by  combining  these  with  the  administra- 
tion of  appropriate  germicidal  drugs,  we  secure  the  most  effect- 
ive inhibitory  influence  possible  at  the  present  time. 

The  drug  management  of  the  symptomatic  phenomena  of  the 
disease  does  not  differ  from  that  applicable  under  other  circum- 
stances. Strychnia,  whisky,  sanguinaria  or  sanguinarin,  small 
doses  of  tartar  emetic,  bryonia,  phosphorus,  etc.,  all  have  their 
places  as  stimulants,  expectorants,  etc.,  but  when  dry  hot  air 
is  given  they  will  sometimes  never  be  indicated  at  all,  and  when 
they  are  it  will  be  for  a  shorter  time  and  in  much  smaller  quan- 
tities than  under  other  conditions. 

When  the  respiratory  area  has  been  greatly  encroached  upon, 
oxygen  inhalations  are  extremely  helpful  and  constitute  a  fairly 
efficient  nerve  stimulant  as  well. 


CHAPTER   VIII. 
ALBUMINURIC  NEPHRITIS    (BRIGHT'S   DISEASE). 

Modifications  of  Clinical  Conditions 
producible  with  Dry  Hot  Air. 

Local  Application. 

This  measure  exercises  no  appreciable  influence  upon  the 
essential  characteristic  symptomatology  or  pathology  of  the 
disease,  and  may  be  dismissed  at  once  from  further  considera- 
tion in  connection  therewith. 

General  Application. 

First,  relief  of  the  headache,  nausea,  respiratory  and  cardiac 
embarrassment,  sometimes  before  the  patient  leaves  the  appa- 
ratus, and  usually  within  twelve  hours. 

Second,  increase  of  the  urinary  excretion  and  of  the  total 
urea  output  in  cases  wherein  these  factors  are  deficient,  whereby 
the  general  tox&mia  is  lessened. 

Third,  diminution  of  the  total  quantity  of  albumin  voided  in 
the  urine,  at  least  when  such  quantity  is  large,  and  sometimes 
complete  elimination  of  this  abnormal  constituent. 

Fourth,  diminution  of  the  dropsy  within  twelve  hours  usually, 
and  sometimes  its  entire  disappearance  within  four  or  five  days. 

Fifth,  absence  of  the  evil  after-effects  of  drugs  which  it  is 
sometimes  necessary  to  administer  for  the  control  of  severe 
symptoms,  because  such  symptoms  are  effectually  removed  by 
dry  hot  air,  which  produces  no  vicious  reaction  when  judi- 
ciously and  properly  administered. 

Sixth,  restoration  to  perfect  health  of  some  of  the  victims 
of  this  disease,  and  to  apparent  health  and  unimpaired  use- 
fulness of  a  large  number. 

RATIONALE  OF  THERMOTHERAPY. 

Etiology. — Unfortunately,  a  positive  knowledge  of  the  pri- 
mary etiological  factors  of  this  disease  is  not  available  at  the 

150 


Albuminuric  Nephritis  (Bright* s  Disease).  151 

present  time,  but  the  general  symptomatology  and  local  tissue 
alterations  are  such  as  to  point  with  a  strong  degree  of  prob- 
ability to  the  presence  in  the  blood  of  some  bodies  irritant  to 
the  renal  structures  during  excretion,  and  which  are  devel- 
oped in  the  tissues  by  reason  of  some  disorder  of  the  sympa- 
thetic nerve  centers  which  govern  the  functions  concerned  in 
tissue  metabolism,  more  particularly  oxidation.  If  this  proves 
to  be  true,  the  disease  will  ultimately  have  to  be  transferred 
from  the  category  of  the  renal  to  that  of  the  constitutional 
disorders;  an  impairment  of  general  metabolism,  of  which  the 
changes  in  the  kidneys  are  but  secondary  local  manifestations. 

The  manner  in  which  the  disease  responds  to  dry  hot  air 
applications  strengthens  this  conception  of  its  causation,  as  does 
also  the  fact  that  the  only  therapeusis  that  has  ever  been  of 
value  in  the  condition  is  that  which  has  had  elimination  of  some 
sort,  or  increase  of  oxidation  in  the  body  as  its  object.  The 
clinical  aspects  of  the  disease  are  also  strongly  indicative  of 
systemic  toxaemia  of  some  sort. 

Speculations  as  to  the  primary  etiology  of  the  disease  are  at 
present  fruitless,  however,  and  fortunately  positive  knowledge 
upon  this  point  is  not  necessary,  so  far  as  the  use  of  dry  hot  air 
in  its  treatment  is  concerned.  We  can  derive  an  ample  num- 
ber of  rational  indications  for  its  employment  from  the  well- 
known  clinical  phenomena. 

Symptomatology  and  Pathology. — Let  us  consider  briefly 
some  of  the  most  prominent  and  constant  of  these  clinical  man- 
ifestations, and  see  if  it  is  possible  to  deduce  anything  as  to 
the  causative  factors,  which  will  constitute  a  logical  basis  Mpon 
which  to  construct  a  rational  therapy. 

First,  there  is  frequently  present  dyspncea  of  variable  degree, 
which  might  be  due  to  pressure  upon  the  pulmonary  innerva- 
tion,  interference  with  the  respiratory  movements  through 
fluid  accumulations  in  the  abdominal  or  pleural  cavities,  or  ir- 
ritation of  the  nerve  endings  in  the  pulmonary  mucosae  by  the 
excretion  of  abnormal,  irritating  bodies  from  the  blood  current. 
In  most  cases  the  first  two  of  these  possible  causative  factors 
can  easily  be  excluded. 

Second,  dropsy,  which  might  be  due  to  change  in  the  blood 


COLLIEGII   Ctr 
L=K\  SlCLwUfc  CHU 


152  Therapeutics  of  Dry  Hot  Air. 

pressure  from  insufficiency  of  the  cardiac  or  arterial  impulses, 
changes  in  composition  of  the  blood  serum,  or  irritation  of 
endothelium  from  toxic  bodies  circulating  in  the  blood  current. 

Third,  digestive  disturbances,  which  could  also  be  due  to 
excretion  by  the  alimentary  mucosa  of  toxic  bodies  present 
in  the  general  circulation. 

Fourth,  a  variable  degree  of  bronchitis,  indicating  an 
abnormal,  irritant  condition  of  the  excretions  of  the  pulmonary 
mucosae. 

Fifth,  affections  of  the  skin,  explicable  upon  the  assumption 
of  either  trophic  aberration,  or  the  presence  in  the  integumen- 
tary excretion  of  abnormal,  irritant  matters. 

Sixth,  a  quickened  heart  action,  accompanied  by  increased 
arterial  tension,  easily  explicable  upon  the  assumption  that 
the  blood  current  holds  in  solution  some  irritant  body  or 
bodies. 

Seventh,  headache,  dizziness,  insomnia,  increased  general 
nervous  and  muscular  irritability,  sometimes  eventuating  in 
the  most  pronounced  convulsive  seizures ;  all  strikingly  indica- 
tive of  the  presence  of  toxic  contamination  of  the  body  fluids. 

Eighth,  the  total  urinary  output  in  the  ordinary  chronic  form 
of  the  disease,  is  usually  somewhat  in  excess  of  the  normal, 
with  lowered  specific  gravity,  a  phenomenon  easily  interpret- 
able  as  the  result  of  renal  irritation,  due  to  the  presence  in  the 
blood  of  an  abnormal  toxic  element.  In  the  more  acute  seizures 
or  exacerbations,  a  diminution  in  quantity  obtains  which 
reaches  the  point  of  complete  suppression  when  the  inflamma- 
tion of  the  secreting  structures  attains  a  sufficient  degree  of 
intensity ;  and  this  inflammation  again  is  undeniably  dependent 
upon  some  antecedent  irritation. 

Ninth,  the  fact  that  albumin  is  usually  found  in  the  urine  is 
explicable  upon  the  same  causative  hypotheses  advanced  in  con- 
nection with  dropsy,  one  of  which,  it  will  be  remembered,  in- 
volved the  presence  of  some  irritating  body  in  the  general 
circulation. 

Tenth  and  last,  the  structural  changes  in  the  kidneys  of  true 
Bright's  disease  are  just  such  as  we  should  expect  to  find  as  the 
direct  or  remote  result  of  inflammatory  action,  which  again 


Albuminuric  Nephritis  (Brig/it's  Disease}.  15.3 

presupposes  the  presence  of  the  element  of  antecedent  irrita- 
tion. 

A  general  debility  of  varying  degree,  frequently  amounting 
to  profound  prostration,  also  usually  accompanies  the  develop- 
ment of  the  renal  symptoms. 

We  have,  then,  ten  of  the  cardinal  elements  which  combine 
to  form  the  clinical  and  pathological  picture  of  Bright's  disease 
of  the  kidneys,  and  four  of  the  minor  symptoms,  for  the  ex- 
planation of  every  individual  one  of  which  the  hypothesis  that 
an  abnormal  substance  or  substances  possessing  toxic  and  irri- 
tant properties  is  contaminating  the  general  circulation  would 
be  sufficient;  and  I  do  not  know  of  any  evidence  tending  to 
show  that  such  a  product  and  condition  do  not  exist  in  this 
situation,  or  that  their  existence  would  not  be  sufficient  to 
explain  all  of  the  pathological  and  clinical  phases  of  this  ail- 
ment. 

Nature  of  Specific  Toxin. — The  next  inquiry  that  would 
naturally  follow  in  this  line  of  reasoning  would  be,  "  What  is 
the  nature  and  evolution  of  this  abnormal  toxic  irritant  ?  " 

We  find  that  the  urine  of  Bright's  disease  commonly  exhibits 
a  deficiency  in  the  quantity  of  urea  normally  present,  and  the 
first  thought  would  be  that  accumulation  in  the  blood  of  an  in- 
tolerable amount  of  this  product  of  catabolism  was  the  offend- 
ing factor.  Indeed,  this  view  of  the  matter  has  been  very  gen- 
erally accepted  until  recently,  but  there  exists  some  evidence 
tending  to  show  that  another  solution  of  the  problem  invites 
consideration. 

First,  although  the  urine  is  deficient  in  urea,  yet  that  does 
not  necessarily  prove  that  the  missing  quantity  has  been  re- 
tained in  the  blood,  as  urea. 

Second,  it  has  been  found  that  urea  injected  into  the  veins 
of  animals  produces  scarcely  any  general  disturbance,  unless 
the  kidneys  have  been  extirpated  or  their  blood-vessels  tied 
off. 

Third,  although  death  always  follows  the  extirpation  of  both 
kidneys  or  ligation  of  their  blood-vessels,  yet  this  does  not 
necessarily  prove  that  death,  under  these  conditions,  is  due  to 
retention  in  the  blood  of  urea,  and  further,  uraemic  phenomena 


1 54  Therapeutics  of  Dry  Hot  A  ir. 

do  not  by  any  means  always  accompany  dissolution  under  these 
conditions.  The  element  of  shock,  which  the  total  destruction 
of  an  element  so  vital  to  the  preservation  of  the  organism  as  is 
the  renal  function,  would  enter  into  the  problem  with  a  force 
that  cannot  be  estimated,  and  that  might  in  itself,  and  exclusive 
of  all  other  causes,  be  sufficient,  in  its  remote  reflex  and  indi- 
rect influences  upon  other  functions  and  the  general  bodily 
metabolism  to  produce  death. 

Fourth,  cases  of  complete  suppression  of  the  urine  for 
periods  varying  from  five  to  twenty-five  days,  and  exhibiting 
no  increase  in  uraemic  signs,  are  not  so  very  uncommon  in 
medical  literature.  In  these  cases  the  blood  is  frequently 
loaded  with  urea,  and  increase  in  the  uraemic  symptoms  could 
hardly  fail  to  appear  if  urea  were  the  active  cause  of  them. 

Fifth,  although  the  induced  perspiration  of  Bright's  disease 
is  said  to  exhibit  a  marked  increase  in  its  toxic  properties,  yet 
the  quantity  of  urea  found  therein  bears  no  adequate  proportion 
to  the  amount  of  benefit  frequently  dependent  upon  the  in- 
duction of  perspiration. 

Sixth,  urea  in  excess  is  by  no  means  always  found  in  blood 
drawn  during  uraemic  seizures. 

Seventh,  urea  is  a  normal,  therefore  an  unirritating  excre- 
tory product  of  the  kidneys,  and  no  evidence  is  at  hand  to  in- 
dicate that  these  organs  would  be  unable  adequately,  and  with 
safety  to  themselves,  to  excrete  any  amount  of  it  which  the 
bodily  metabolism  was  capable  of  elaborating,  or  that  urea,  in 
itself,  is  capable  of  provoking  inflammation  in  these  organs, 
however  great  the  quantity  which  they  may  have  been  called 
upon  to  dispose  of;  and  inflammation  of  the  renal  excretory 
structures  of  some  degree  is  an  invariable  concomitant  of 
uraemic  manifestations. 

Eighth,  if  we  assume  that  an  excessive  amount  of  urea  in  the 
blood  is  the  essential  causative  element  of  uraemic  phenomena, 
we  must  necessarily  also  assume  that  one  of  two  antecedent 
conditions  obtains  in  order  to  account  for  its  presence  there : 

First,  that  the  primary  and  initial  lesion  is  the  inflammatory 
process  in  the  kidney,  by  reason  of  which  the  kidney  is  so 
crippled  tl.at  it  is  unable  to  excrete  the  normal  quantity,  where- 


Albuminuric  Nephritis  (Bright 's  Disease).  155 

by  the  same  is  thrown  back  into  the  blood  current;  and  there 
is  no  satisfactory  evidence  available  to  support  this  suppo- 
sition. 

Second,  that  some  aberration  of  metabolic  function  causes 
urea  to  be  elaborated  in  such  quantities  that  the  kidney  is 
unable  to  excrete  it ;  and,  as  stated  above,  there  is  no  conclusive 
evidence  available  to  indicate  that  urea  is  so  present,  that  it 
would  be  possible  for  the  organism  to  elaborate  urea  in 
sufficient  quantity  to  produce  this  effect,  or  again,  that  urea 
would  be  able  in  any  possible  quantity  to  produce  the  inflam- 
matory renal  pathology  which  is  always  observed  in  this 
disease. 

These  facts  are  vital,  and  any  theory  that  does  not  satisfy 
their  claims  is  not  entitled  to  unmodified  acceptance. 

Therefore,  it  would  appear  that  there  is  justification  for  look- 
ing for  something  besides  urea,  as  the  direct  exciting  cause  of 
uraemic  phenomena,  and  as  inflammation  of  the  kidney  struc- 
tures, which  would  partake  of  the  nature  of  an  external  factor, 
can  be  disregarded  as  a  primary  cause,  we  must  look  for  the 
origin  at  the  other  end  of  the  equation,  that  is,  within  the  body. 
Now,  urea  is  a  substance  of  a  moderately  high  degree  of  oxida- 
tion, and,  as  the  clinical  phenomena  of  Bright's  disease  by  no 
means  constantly  indicate  that  excessive  oxidation  is  taking 
place,  we  must  consider  that  it  is  among  the  sub-oxidation 
products  or  structural  antecedents  of  urea  that  we  may  expect 
to  find  the  characteristic  toxin. 

Finally,  it  will  be  instructive,  in  this  connection,  to  ascertain 
whether  or  not  the  actions  of  remedial  measures  which  have 
hitherto  been  found  useful,  will  shed  any  light  upon  the 
subject. 

This  point  may  be  disposed  of  very  briefly,  and  as  follows : 

Every  therapeutical  measure  that  has  attained  a  lasting  place 
in  the  popular  management  of  this  disease  has  exerted  its  prin- 
cipal influence  toward  the  induction  of  one  or  more  of  the  fol- 
lowing effects,  viz. : 

First,  increased  elimination,  as  by  diuresis,  diaphoresis,  and 
purging. 

Second,  dilution  of  the  body  fluids,  whereby  the  effect  upon 


156  Therapeutics  of  Dry  Hot  Air. 

the  nerve  centers  of  a  toxin  in  the  circulation  would  be  less- 
ened, as  by  increasing  the  amount  of  water  ingested,  milk  diet, 
etc.,  and  by  bleeding,  which  secures  practically  the  same  result 
as  far  as  the  toxin  is  concerned,  but  in  another  way. 

Third,  as  bearing  more  particularly  upon  the  question  of 
whether  or  not  the  toxin  is  a  .sub-oxidation  product,  lessening 
the  amount  of  metabolic  elaboration  demanded  of  the  trophic 
nerve  centers,  as  by  restriction  of  the  diet. 

Fourth,  stimulation  of  metabolism,  which,  in  this  connection, 
means  oxidation,  by  the  administration  of  iron  and  other  gen- 
eral tonics  and  the  prescription  of  judiciously-regulated  exer- 
cise. 

Another  fact  bearing  upon  this  point  is  the  well-known  evil 
effect  upon  the  victims  of  Bright's  disease  of  administering 
any  agent  which  exhibits  a  tendency  to  check  oxidation  or 
metabolism,  as  alcohol,  coal-tar  derivatives,  etc. 

We  find,  then,  that  Bright's  disease  is  a  condition  character- 
ized by,  and  the  clinical  phenomena  of  which  are  probably  due 
to  severe  systemic  toxaemia  of  some  sort,  and  that  the  toxin 
concerned  is  probably  a  sub-oxidation  product  which  would 
normally  be  elaborated  into  urea.  The  occurrence  of  sub- 
oxidation  means,  of  course,  impaired  metabolism,  and  im- 
paired metabolism  implies  inefficient  functionation  of  the  sym- 
pathetic nerve  centers,  because  it  is  under  and  through  the 
control  of  these  centers  that  metabolic  processes  are  elabo- 
rated. 

Therapeutic  Indications. — The  objects  of  treatment  in 
Bright's  disease,  as  indicated  by  the  clinical  phenomena  and 
what  is  known  of  the  pathology,  would  be,  then,  to  secure  .  . 

First,  an  increase  in  vigor  in  the  functionation  of  the  deep 
trophic  nerve  centers,  impairment  of  which  is  probably  respon- 
sible for  the  presence  in  the  body  of  toxic  products  of  imperfect 
metabolism. 

Second,  a  direct  increase  of  the  oxidation  processes  in  the 

body,  whereby  it  will  be  possible  to  elaborate  the  chemical 

structure  of  the  toxic  bodies  to  a  point  which  will  admit  of 

excretion  without  irritation ;  in  other  words,  to  oxidize  them 

'into  urea. 


Albuminuric  Nephritis  (Bright 's  Disease}.  157 

Third,  to  secure  as  active  an  elimination  as  possible,  in  order 
that  the  system  may  be  relieved  of  as  much  of  the  toxin  as 
possible  in  the  shortest  possible  time. 

General  Application. — Theoretically,  this  procedure  should 
constitute  an  ideal  therapeutical  measure  in  connection  with 
Bright's  disease;  it  apparently  satisfies  all  three  of  the  indica- 
tions for  treatment. 

Practically  it  does  not  prove  to  be  as  profoundly  and  uni- 
formly curative  as  might  be  expected  from  its  physiological 
action,  but  even  under  such  limitations  it  is  the  most  effective 
and  satisfactory  remedy  now  at  our  command,  especially  in 
acute  cases  and  exacerbations  of  the  chronic  form. 

In  cases  characterized  by  large  amounts  of  albumin  in  the 
urine,  and  deficiency  in  the  urea  output,  the  former  constituent 
lessens  markedly  soon  after  the  treatment  is  inaugurated,  and 
the  latter  is  increased  sometimes  one  hundred  per  cent,  during 
the  twenty-four  hours  succeeding  the  first  application.  In 
chronic  cases,  exhibiting  a  practically  normal  urea  output,  no 
increase  in  this  excretion,  and  no  very  marked  or  immediate 
diminution  in  the  quantity  of  albumin,  may  be  apparent,  but  the 
evidences  of  toxaemia,  such  as  headache,  dizziness,  etc.,  dis- 
appear rapidly.  The  patient  is  restored  to  usefulness  and 
enabled  to  resume  his  daily  occupation,  even  when  the  same 
involves  pretty  strenuous  application,  but  albumin  may  persist 
in  the  urine  for  years.  Some  of  these  cases  are  restored  to 
apparently  perfect  health. 

ILLUSTRATIVE  CASES. 
Acute  Albuminuric  Nephritis. 

Case  I. 

G.  B.,  aged  fifteen  years,  was  brought  to  the  sanitarium  on 
April  6,  1904,  by  Dr.  W.  S.  Randall,  of  Derby,  Conn.,  at  four 
o'clock  P.  M.  The  history  of  the  case  up  to  that  time  is  quoted 
from  a  letter  written  me  by  Dr.  Randall  on  November  9,  1904, 
as  follows : 

"I  was  called  on  February  n,  1904,  to  attend  this  boy, 
and  found  him  with  a  high  fever ;  forty-eight  hours  after  a  rash 
appeared  and  a  diagnosis  of  scarlatina  was  made.  He  was 
given  the  treatment  usual  in  such  cases — tr.  ferri.  chlor.,  a 


158  Therapeutics  of  Dry  Hot  Air. 

gargle  for  his  pharyngitis,  and  kept  in  a  warm  room  under  the 
care  of  a  nurse.  A  light  and  easily  digested  diet  was  ordered, 
and  an  antiseptic  ointment  applied  to  the  body  at  intervals. 

"  All  went  well,  fever  subsiding  and  patient  beginning  to  get 
about  his  room  and  take  more  food,  until  about  March  6th, 
when  oedema  began  to  show  itself  about  his  feet  and  ankles. 
Urinalysis  showed  small  percentage  of  albumin,  the  total  quan- 
tity of  urine  passed  being  small  in  amount,  and  of  high  specific 
gravity. 

"  Diuretics  and  Basham's  mixture  were  given,  which  seemed 
to  relieve  the  early  stages,  but,  as  the  case  progressed,  the 
oedema  extended  up  the  body,  involving  the  thighs,  hips,  and 
scrotum.  Dry  cups  over  the  kidneys  and  sweating  were  freely 
used,  and  some  relief  resulted  apparently,  but  still  the  oedema 
persisted,  and  the  patient  seemed  to  make  but  little  headway. 

"  Thus  the  case  ran  along,  improving  somewhat,  until  March 
27th,  when  it  was  decided  to  move  him  to  his  home,  he  having 
been  in  a  boarding  house  up  to  this  time.  A  little  cough  had 
developed,  and  some  shortness  of  breath  was  then  present. 

"  After  his  removal  in  a  close  carriage,  a  distance  of  one  and 
a  half  miles,  he  seemed  rapidly  to  get  worse.  Dyspnoea  and 
cedema  increased,  marked  dullness  developed  over  the  lower 
chest  wall,  and  abdomen  became  distended.  The  kidneys  were 
getting  into  an  intensely  congested  state,  as  was  shown  by  the 
presence  of  a  high  percentage  of  blood  in  the  urine. 

"  Diuretics,  saline  cathartics,  and  heart  stimulants  were  freely 
administered,  with  only  temporary  relief. 

"  From  this  time  the  case  grew  steadily  worse,  until,  on  the 
5th  of  April,  I  was  suddenly  called  to  his  bedside  to  find  him 
suffering  from  extreme  dyspnoea,  and  in  such  an  alarming 
condition  generally  that  I  did  not  expect  him  to  live  until  the 
following  morning.  I  administered  an  hypodermic  of  mor- 
phine and  atropine,  which  temporarily  relieved  his  paroxysm, 
and  the  following  day  after  a  hurried  consultation  over  the 
telephone  I  took  him  to  your  sanitarium  for  dry  hot  air  treat- 
ment." 

When  this  patient  was  admitted  to  the  sanitarium  the  follow- 
ing conditions  obtained : 

Marked  prostration  and  urgent  dyspnoea,  which  forced  him 
to  maintain  an  erect  sitting  posture  and  made  speech  a  matter 
of  considerable  difficulty;  patient  was  coughing  constantly, 
lips  were  cracked  and  covered  with  large,  bloody  scabs. 

His  pulse  was  124,  weak,  intermittent,  and  irregular,  mouth 
temperature  99.2°  F.,  respiration  52.  The  body  was  oedematous 
throughout,  but  especially  so  in  the  legs  and  feet,  the  last-men- 
tioned members  being  about  twice  their  natural  size.  Coarse 


Albuminuric  Nephritis  (Bright 's  Disease}.  159 

rales  were  diffused  over  both  lungs  and  marked  dullness, 
almost  flatness,  presented  over  their  lower  portions. 

He  was  passing  a  small  quantity  of  very  dark  brown  urine 
of  specific  gravity  1001,  which  contained  a  large  amount  of 
albumin,  some  cylindroids  and  degenerated  cells,  a  few  hyaline 
and  many  granular  casts,  red  blood  cells,  and  small  round  cells 
from  the  renal  tubules. 

It  was,  in  short,  a  typical  case  of  dangerously  severe  acute 
nephritis,  so  severe  that  Dr.  Randall  "  did  not  expect  him  to 
live  until  the  following  morning "  the  night  previous ;  he 
afterwards  told  me  that  he  was  very  doubtful  as  to  his  ability 
to  get  him  to  the  sanitarium  alive. 

He  was  given  a  body  dry  hot  air  treatment  at  once;  one- 
tenth  of  a  grain  of  calomel  combined  with  sodium  carbonate 
was  administered  every  half-hour  until  one  grain  had  been 
ingested,  one-sixtieth  of  a  grain  of  strychnia  sulphate  every  six 
hours,  and  one-eighth  of  a  grain  of  morphine  combined  with 
atropine  was  given  hypodermically  three  times .  during  the 
night.  His  diet  was  cut  down  to  milk  and  beef  tea. 

By  the  next  morning  a  diminution  of  the  dyspnoea,  cough, 
and  oedema  was  perceptible,  and  he  had  slept  at  intervals  during 
the  night  a  total  of  five  and  three-quarters  hours,  propped  up 
by  pillows;  he  felt  and  was  appreciably  improved.  As  the 
calomel  had  not  acted,  two  drams  of  magnesium  sulphate  were 
ordered  administered  every  two  hours  until  the  bowels  moved. 
At  10  A.  M.  his  pulse  was  112,  mouth  temperature  99°  R,  res- 
piration 36. 

At  ii  A.  M.  another  general  dry  hot  air  application  was 
administered;  at  4  p.  M.  the  bowels  moved  loosely  and  freely, 
and  at  5  P.  M.  one-fortieth  of  a  grain  of  strychnia  sulphate  was 
administered,  the  preceding  dose  having  been  given  at  midnight. 
The  improvement  in  the  symptoms  noted  in  the  morning  had 
increased  during  the  day,  the  patient  now  being  able  to  recline 
upon  his  bed  propped  up  by  pillows.  A  noticeable  decrease 
had  also  obtained  in  the  dullness  over  the  pulmonary  areas  and 
in  the  number  of  rales  audible. 

The  urine  passed  during  these  first  twenty-four  hours  meas- 
ured two  pints,  of  specific  gravity  1001,  color  very  dark  brown 
with  coffee-grounds  sediment,  and  it  contained  a  large  amount 
of  albumin,  numerous  casts  and  red  blood  cells. 

To  make  a  long  story  short,  this  patient  was  under  treat- 
ment at  Newhope  one  week,  during  which  period  he  was  given 
four  general  dry  hot  air  treatments,  three  static  induced  electri- 
cal applications  over  and  through  the  kidneys,  and  three  static 
wave  current  applications  to  his  spine.  The  first  electrical 
treatment  was  given  at  noon  of  the  third  day,  so  that  no  part 


160  Therapeutics  of  Dry  Hot  Air. 

of  the  very  significant  modifications  of  symptomatology  noted 
during  the  period  preceding  can  be  in  any  degree  attributed 
to  electricity. 

After  the  first  twenty-four  hours,  the  only  medicine  admin- 
istered was  one-sixtieth  of  a  grain  of  strychnia  sulphate  every 
six  hours  and  magnesium  sulphate  in  two-dram  doses  every 
two  hours,  when  it  was  necessary  to  move  the  bowels.  One 
movement  a  day  was  all  that  it  was  attempted  to  produce. 

The  diet  throughout  consisted  solely  of  milk,  beef  tea, 
chicken  broth,  a  little  rice,  and  a  small  piece  of  stale  bread 
once  daily.  From  a  pint  to  a  pint  and  a  half  of  water  was 
administered,  in  small  quantities  at  a  time,  during  the  twenty- 
four  hours. 

The  improvement,  the  inauguration  of  which  is  described 
above,  steadily  continued  until  he  was  discharged,  when  he 
went  home  to  Derby,  a  distance  of  ten  miles,  on  a  trolley  car, 
walking  from  the  sanitarium  to  the  cars  a  distance  of  half  a 
block.  The  dyspnoea  and  cough  had  entirely  disappeared,  and, 
during  the  last  three  nights  of  his  stay,  he  had  slept  lying  down 
in  bed;  the  oedema  of  the  lungs  and  effusion  into  the  pleural 
cavities  had  entirely  disappeared,  and  the  dropsy  had  vanished 
from  all  parts  of  the  body  except  about  his  ankles  and  feet. 
He  was  as  hungry  as  any  healthy  boy  of  his  age  could  be, 
begging  for  something  to  eat  with  tears  in  his  eyes. 

The  urine  passed  during  the  second  twenty-four  hours  meas- 
ured three  pints,  as  contrasted  with  two  pints  during  the  like 
period  of  time  preceding,  of  specific  gravity  /oop,  as  contrasted 
with  1001,  tzvo  per  cent.,  by  volume,  of  albumin  in  place  of  the 
large  amount  contained  in  the  preceding  specimen,  and  a  de- 
cided lessening  in  the  quantity  of  blood  and  number  of  casts 
present. 

That  passed  during  the  third  twenty-four  hours  measured 
eight  pints,  exhibited  a  specific  gravity  of  1006,  a  trace  of  albu- 
min so  small  as  not  to  be  susceptible  of  exact  determination 
by  the  ordinary  methods,  and  estimated  at  one-eighth  of  one  per 
cent.,  and  no  casts.  From  this  time  until  he  was  discharged  the 
quantities  passed  during  the  successive  periods  of  twenty-four 
hours  varied  from  three  to  six  pints,  the  specific  gravity  from 
1006  to  1010,  with  a  small  trace  of  albumin  and  an  occasional 
cast. 

The  progress  of  the  case  since  leaving  us  is  thus  described 
by  Dr.  Randall,  who  thereafter  had  him  in  charge. 

"  After  his  return  he  was  put  upon  a  strict  milk  diet,  given 
freely  of  water,  and  a  tonic  treatment  administered.  The 
static  current  was  used  twice  a  week  over  region  of  kidneys 
from  April  3oth  to  July  i6th,  1904.  The  urine  gradually 


Albuminuric  Nephritis  (Bright' s  Disease).  161 

cleared  from  the  blood  cells  and  albumin,  and  the  last  examina- 
tion on  July  1 6th  showed  no  trace  of  either.  He  has  remained 
well  ever  since." 

Although  this  case  constitutes  very  good  evidence  as  to  the 
value  of  general  dry  hot  air  applications  in  acute  Bright's 
disease,  yet  it  by  no  means  exhibits  the  almost  magical  changes 
that  are  sometimes  producible  in  its  symptomatology  by  the 
employment  of  this  agent.  The  following  is  an  instance  in 
point : 

Case  II. 

Mr.  E.  K.,  aged  forty-eight  years,  was  admitted  to  the  sani- 
tarium for  treatment  at  noon,  January  13,  1902.  Three  months 
previously  he  had  begun  to  notice  that  his  feet  were  swelling, 
that  he  was  having  occasional  headaches,  attacks  of  vertigo, 
and  difficulty  in  breathing  during  exertion,  but  thought  little 
of  it,  as  he  was  very  fleshy.  The  symptoms  shortly  increased 
to  such  an  extent  that  he  consulted  a  physician,  who  recog- 
nized the  trouble,  judging  from  his  prescriptions,  but  did  not 
inform  the  patient.  He  continued  to  grow  rapidly  worse  under 
treatment,  and  soon  after  consulted  another  with  a  like  absence 
of  results  as  far  as  improvement  was  concerned. 

Upon  his  admission  his  condition  was  one  of  great  gravity. 
He  had  been  unable  to  attend  to  his  ordinary  duties  for  three 
weeks.  The  subcutaneous  tissues  all  over  the  body  were 
greatly  distended  and  fluid  was  present  in  the  abdominal  and 
pleural  cavities. 

Respiration  was  irregular,  nearly  impossible  in  the  recum- 
bent, and  very  difficult  in  the  upright  positions,  and  ranged 
from  thirty-six  to  forty  cycles  per  minute.  Pulse  small  and 
wiry,  irregular,  and  from  100  to  115  per  minute.  The  least 
exertion  brought  on  alarming  acceleration  and  embarrassment 
of  both  respiratory  and  cardiac  functions.  Temperature  99.1° 
F.  Patient  was  profoundly  prostrated.  Weight  j<?5  pounds. 
Height,  five  feet  eleven  inches. 

He  was  passing  urine  with  a  specific  gravity  of  1002,  which 
was  loaded  with  albumin  and  casts.  As  the  twenty-four  hours' 
urine  had  not  been  collected  previously  to  his  admission,  the 
total  urea  output  for  that  period  was  not  determinable,  but  as 
I  was  unable  to  convince  myself  that  the  quantity  was  excess- 
ive, the  low  specific  gravity  would  indicate  that  it  must  have 
been  considerably  below  the  normal. 

He  was  given  a  body  dry  hot  air  treatment  at  4  P.  M.,  during 
which  he  perspired  as  I  had  never  seen  a  patient  perspire  be- 


1 62  Therapeutics  of  Dry  Hot  Air. 

fore.  By  the  time  the  treatment  was  concluded,  his  respiratory 
oppression  had  noticeably  diminished,  his  pulse  had  increased 
to  a  marked  degree  in  volume,  and  the  irregularity  which  had 
previously  characterized  both  functions  was  considerably  less 
evident.  The  skin  upon  his  legs  and  abdomen,  which  had  pre- 
viously been  so  tense  as  to  threaten  rupture,  was  wrinkled,  the 
subcutaneous  tissue  could  be  felt  as  having  softened  in  a 
marked  degree,  and  he  expressed  surprise  at  the  facility  with 
which  he  could  perform  bodily  movements,  as  compared  with 
the  painful  stiffness  and  sense  of  distention  which  accompanied 
his  efforts  before  the  treatment. 

That  night  he  was  able  to  sleep  considerably  lying  down, 
and  during  the  next  twenty-four  hours  the  following  changes 
were  observed : 

First,  the  respiratory  and  cardiac  embarrassment  continued 
to  decrease,  the  irregularity  characterizing  the  latter  function 
entirely  disappearing. 

Second,  the  dropsy  rapidly  diminished  until  by  night  it  had 
entirely  disappeared  except  in  the  legs,  and  the  condition  of 
these  members  was  by  no  means  formidable. 

Third,  he  was  resting  comfortably  and  took  his  nourishment 
with  enjoyment. 

Fourth,  he  had  perspired  more  or  less  continuously  since 
the  treatment,  and  had  passed  four  and  a  half  litres  of  urine, 
with  a  specific  gravity  of  1022  as  compared  with  the  1002  ex- 
hibited by  the  specimen  taken  before  treatment,  which  figure 
indicated  that  about  four  times  the  normal  amount  of  urea  had 
been  excreted  during  this  period. 

Fifth,  a  decrease  of  about  fifty  per  cent,  in  the  quantity  of 
albumin  obtained. 

Sixth,  his  weight  was  280  1-2  pounds,  as  contrasted  with  325 
pounds  on  the  previous  day. 

He  received  ten  body  dry  hot  air  treatments  during  the 
next  two  weeks,  at  the  end  of  which  time  he  felt  well  enough 
to  go  home  and  to  work,  which  he  did,  against  my  advice  and 
judgment,  however.  During  these  two  weeks  he  had  improved 
steadily  in  all  directions.  The  albumin  in  the  urine  continu- 
ously decreased,  as  did  also  the  dropsy  of  the  legs.  The  specific 
gravity  of  the  urine  ranged  from  1004  to  1014,  except  after 
the  body  treatment,  when  it  sometimes  reached  1020  and  over. 
The  daily  quantity  of  urine  passed  ranged  from  2  to  4  1-2  litres. 
He  began  to  go  out  for  short  walks  after  the  first  five  days. 
During  the  last  few  days  absolutely  no  dropsy  was  discernible 
in  the  morning,  but  it  would  appear  to  some  extent  in  his  legs 
at  night,  or  after  he  had  been  out  walking. 

The  other  remedial  measures,  which  were  applied  simultane- 


Albumimiric  Nephritis  (Bright 's  Disease).  163 

ously  with  the  dry  hot  air,  were  restriction  of  the  diet  to 
milk,  junket,  and  cereals,  for  the  first  five  days,  after  which 
eggs  and  milk  toast  were  added ;  a  grain  and  a  half  of  calomel 
in  divided  doses  three  times  during  the  two  weeks ;  general 
static  electrical  applications,  once  daily;  and  during  the  last 
four  days  of  his  stay  a  gentian  and  iron  tonic,  which  he  was 
directed  to  continue  after  he  left. 

I  saw  this  patient  again  a  year  later,  and  although  he  had 
suffered  another  exacerbation  in  the  meantime  under  the  care 
of  another  physician,  yet  he  was  then  steadily  and  uninter- 
ruptedly pursuing  his  vocation  of  locomotive  engineer.  As 
long  as  he  took  proper  care  of  himself,  he  experienced  no  dis- 
ability, and  although  some  albumin  was  still  constantly  present 
in  his  urine,  no  dropsy  or  indication  of  the  disease  other  than 
the  albumin  was  discoverable. 

Chronic  Albuminuric  Nephritis. 

Case  III. 

Mr.  J.  H.,  bookkeeper,,  aged  thirty-three  years,  was  referred 
to  us  for  treatment  by  Dr.  Albert  C.  Geyser,  of  New  York, 
N.  Y.,  and  was  admitted  to  the  sanitarium  at  noon  on  March 
30th,  1904. 

The  existence  of  chronic  Bright's  disease  had  been  accident- 
ally discovered  four  months  previously  through  an  examination 
for  a  life  insurance  policy,  and  during  this  period  the  ordinary 
medicinal,  dietary,  and  hygienic  treatment  had  been  adminis- 
tered by  one  of  the  best  and  most  widely-known  of  New 
York's  physicians;  there  could,  therefore,  be  no  doubt  as  to 
the  wisdom  and  good  judgment  with  which  the  management 
of  the  case  had  been  directed. 

During  this  period  there  had  been  present,  with  a  fair  degree 
of  constancy,  aching  pains  in  the  loins,  frequent  attacks  of 
dizziness,  and  some  physical  weakness  and  prostration,  by 
reason  of  which  he  tired  easily  upon  exertion.  These  symptoms 
interfered,  more  or  less,  with  his  comfort  and  the  satisfactory 
performance  of  the  duties  of  his  vocation,  and,  as  no  improve- 
ment obtained  under  the  ordinary  remedial  measures,  he  sought 
the  advice  of  Dr.  Geyser,  who  recognized  at  once  the  meager 
prospects  of  improvement  offered  by  a  continuance  along  the 
same  old  line  under  the  circumstances,  and  recommended  the 
application  of  dry  hot  air. 

According  to  Dr.   Geyser's  letter  of  information,   he   was 


1 64  Therapeutics  of  Dry  Hot  A  ir. 

passing,  before  his  admission  to  the  sanitarium,  a  good  quan- 
tity of  urine  of  specific  gravity  1005  to  1010,  which  contained 
from  ten  to  twelve  per  cent.,  by  volume,  of  albumin  and  some 
granular  casts. 

His  general  condition  when  he  entered  was  marked  by  con- 
siderable bodily  weakness,  frequent  attacks  of  dizziness,  some- 
times two  or  three  in  a  day,  aching  pain  through  the  loins, 
and  pronounced  anaemia.  No  dropsy  of  any  sort  or  degree 
was,  or  had  been,  in  evidence. 

He  was  put  upon  a  diet  consisting  of  one  quart  of  milk  per 
day,  and  more  if  he  wanted  it ;  one  quart  of  water  per  day,  and 
more  if  he  wanted  it;  cereals  and  white  meats,  and  later  this 
was  expanded  to  include  red  meats  or  fish  once  a  day,  the 
common  vegetables  and  plain  puddings. 

During  the  five  weeks  of  his  stay  at  Newhope,  he  received 
ten  body  dry  hot  air  applications,  eleven  applications  of 
mechanical  vibratory  stimulation  to  the  posterior  spinal  nerves, 
ten  static  wave  applications  localized  over  the  spinal  cord,  and 
four  localized  over  the  kidneys  posteriorly,  five  applications  of 
the  static  induced  current  through  the  kidneys,  nine  general 
high  frequency  treatments  administered  by  means  of  Piffard's 
auto-condensation  cushion,  and  four  applications  of  the  con- 
tinuous current  to  the  entire  length  of  the  spine. 

The  medicines  administered  during  the  first  two  weeks  con- 
sisted solely  of  magnesium  sulphate  in  two-dram  doses  every 
two  hours,  when  it  was  necessary  to  move  the  bowels ;  and  this 
drug  was  continued  p.  r.  n.  during  the  whole  of  his  stay.  Alka- 
lithia  was  then  given  in  dram  doses  three  times  daily  for  four 
days,  but  was  then  abandoned  because  it  seemed  to  induce  some 
muscular  weakness.  One  dram  of  the  syrup  of  hydriodic  acid 
and  an  iron  and  strychnia  pill  were  then  administered  three 
times  daily  until  his  discharge. 

Improvement  in  all  directions  commenced  at  once,  and  con- 
tinued steadily  but  slowly  throughout  the  course  of  treatment. 
During  the  last  two  weeks  of  his  stay  he  had  no  pain  in 
the  loins,  no  dizziness,  and  his  physical  prostration  had  entirely 
disappeared. 

The  total  quantity  of  urine  passed  during  the  twenty-four 
hours  succeeding  the  first  general  dry  hot  air  application  meas- 
ured six  pints,  exhibited  a  specific  gravity  of  1009,  and  con- 
tained a  large  amount  of  albumin  (amount  not  quantitatively 
determined),  granular  and  hyaline  casts,  and  small  round  cells 
from  the  renal  tubules. 

That  passed  during  the  twenty-four  hours  ending  April  nth, 
or  two  weeks  after  admission,  measured  seven  and  one  half, 
pints,  exhibited  a  specific  gravity  of  1009,  and  two  and  one-half 


Albuminuric  Nephritis  (Bright's  Disease).  165 

per  cetit.,  by  volume,  of  albumin  against  the  ten  and  twelve  per 
cent,  which  obtained  before  treatment  was  commenced. 

Although  the  specific  gravities  of  the  specimens  remained 
the  same  as  recorded  above,  yet  the  greater  total  quantity  of  the 
later  specimen  demonstrated  that  the  excretion  of  urea  was 
greater  during  the  later  period. 

Thereafter,  the  total  quantity  passed  during  the  twenty-four 
hour  periods  varied  from  six  to  seven  pints,  the  specific  gravity 
from  1009  to  1012,  and  the  quantity  of  albumin  from  two  and 
one  half  to  four  per  cent,  by  volume.  Casts  and  epithelial  cells 
from  the  renal  tubes  were  sometimes  absent  from  the  urine  for 
more  than  twenty-four  hours  at  a  time ;  at  such  times  the 
microscopical  findings  were  almost  absolutely  negative  in  every 
particular. 

A  letter  received  from  this  patient  on  August  18,  1904, 
stated  that  he  was  still  under  treatment  by  Dr.  Geyser,  and  an- 
nounced his  intention  of  visiting  the  sanitarium  again  (not  for 
treatment,  however),  where  he  "  was  put  back  on  the  road  to 
health  and  happiness." 

Dr.  Geyser  wrote  me  under  date  of  October  18,  1904,  that 
the  patient  was  "  still  under  treatment  with  me,  dietetic,  hygi- 
enic, vibration,  and  electricity,  each  as  indicated ;  no  drugs. 
Urine  still  exhibits  low  specific  gravity  and  contains  the  usual 
amount  of  albumin.  Patient  feels  good,  and  follows  his  voca- 
tion as  bookkeeper  every  day,  appetite  good,  sleeps  well,  has 
no  dizzy  spells;  is  symptomatically  very  much  improved." 

These  three  cases  illustrate  very  well  the  different  phases 
and  degrees  of  profundity,  of  the  influence  obtainable  with  dry 
hot  air  in  this  disease. 

They  all  three  exhibit  in  common  its  power  to  increase  the 
total  urinary  and  urea  output  in  cases  manifesting  deficiency  in 
these  excretions,  to  decrease  the  quantity  of  albumin  voided, 
and  to  relieve  the  headache,  dyspnoea,  and  other  evidences 
of  toxaemia. 

Cases  I  and  II  illustrate  its  influence  upon  acute  dropsy,  Case 
II,  in  particular,  demonstrating  the  striking  rapidity  with 
which  reduction  is  sometimes  effected. 

Case  III  exemplifies  its  effect  upon  many  of  the  more 
chronic  forms  of  the  affection,  wherein  it  does  not  produce  en- 
tire disappearance  of  the  albumin,  or  restoration  of  specific 
gravity  to  normal,  but  does  restore  the  patient  to  unimpaired 
iisefulness  and  apparent  health  which,  as  far  as  our  present 


1 66  Therapeutics  of  Dry  Hot  Air. 

knowledge  goes,  are  susceptible  of  maintenance  as  long  as  good 
judgment  and  intelligent  supervision  are  exercised  in  regulat- 
ing his  habits  and  mode  of  life,  especially  as  regards  the  occa- 
sional administration  of  dry  hot  air  treatments  and  dietary 
restriction. 

Furthermore,  it  will  be  observed  that  each  of  the  above- 
described  results  was  obtained  in  spite  of  the  fact  that  the 
patients  were  all  under  the  treatment  during  a  ridiculously 
short  time  in  which  to  expect  curative  effects  in  an  ailment 
exhibiting  such  intractability  as  characterizes  true  Bright's 
disease;  Case  I  was  treated  for  one  week,  Case  II  for  two 
weeks,  and  Case  III  for  five  weeks. 

Finally,  that  the  results  obtained  are  justly  accreditable  to 
dry  hot  air  is  evidenced  by  the  fact  that  additional  remedial 
measures,  other  than  those  which  had  already  been  and  were 
being  employed  without  benefit,  were  not  combined  with  the 
thermal  element  until  after  these  striking  modifications  of 
symptomatology  had  become  manifest. 
TREATMENT. 

General  Dry  Hot  Air  Application. — The  technique  of  its 
administration  is  very  simple.  The  majority  of  these  cases  are 
encountered  in  persons  whose  arteries  have  not  yet  taken  on 
atheromatous  changes,  hence  particular  care  in  this  direction  is 
not  necessary.  There  is  usually  present,  however,  a  high  pulse 
tension,  and,  during  the  first  treatment,  the  heat  should  be  in- 
creased rather  slowly,  watching  this  phenomenon  meanwhile. 
It  usually  lessens  during,  or  immediately  after,  the  first  seance. 
If  no  undue  exhaustion  follows  the  first  treatment,  and  it  very 
rarely  does,  the  application  may  be  repeated  the  following  day, 
and  thereafter  every  second  or  third  day. 

The  temperature  of  the  first  treatment  should  be  at  least 
300°  F.,  and  in  those  succeeding  it  should  be  pushed  to  350° 
or  400°  F.,  and  run  up  as  quickly  as  the  patient's  tolerance  will 
permit.  By  this  technique  is  secured  a  sudden  strong  impulse 
upon  the  nerve  centers,  which  it  is  our  aim  to  influence  as  pro- 
foundly as  possible. 

The  after-care  of  the  patient  is  that  usual  to  the  body  treat- 
ment. 


Albuminuric  Nephritis  (Bright" s  Disease).  167 

I  have  not  yet  treated,  and  I  have  not  heard  of  anyone  else 
having  treated,  a  case  of  complete  uraemic  coma  with  dry  hot 
air.  It  is  reasonable  to  suppose,  however,  that  it  would  act 
as  efficiently  in  this  condition  as  in  the  milder  forms  of  intoxi- 
cation, and  if  this  proves  to  be  true  it  will  have  forged  another 
great  claim  upon  our  respect. 

Additional  Remedial  Measures. 

Diet. — The  diet  should  always  be  cut  down  to  milk,  and  milk 
only,  if  possible,  until  the  toxaemia  has  been  gotten  thoroughly 
under  control,  and  should  then  be  regulated  according  to  the 
conditions  obtaining  in  the  individual  case.  The  more  water 
the  patient  drinks  the  better,  and  no  fear  need  be  entertained 
that  it  will  increase  any  dropsy  that  may  be  present ;  the  tend- 
ency is  entirely  in  the  reverse  direction. 

Clothing. — Woolen  undergarments  of  light  weight  in  sum- 
mer, and  heavier  in  winter,  should  be  worn  at  all  times  by  the 
victims  of  this  disease.  Chilling  the  surface  of  the  body  inter- 
feres with  the  emunctory  functions  of  the  skin  and  may  exer- 
cise an  evil  influence,  directly  or  indirectly,  upon  structures 
in  the  interior  of  the  body  whose  functions  are  concerned  in 
metabolism. 

Drugs. — The  bowels  should  be  kept  freely  open  by  the 
use  of  calomel  and  salines  when  any  inclination  towards 
constipation  is  evident,  and  digestive  disturbances  should  be 
corrected,  but  aside  from  this  drugs  are  very  rarely  necessary 
except  as  tonics,  when  dry  hot  air  is  being  administered,  and 
the  less  medicine  the  patient  ingests  the  better  usually. 

Electricity. — Next  in  importance  to  general  applications  of 
dry  hot  air  may  be  placed  the  static,  static  derived,  and  high 
frequency  electrical  currents,  especially  in  the  chronic  forms  of 
the  disease.  Gratifying  reports  of  the  efficiency  of  these  modal- 
ities have  been  made  by  Neiswanger,  of  Chicago;  Reed,  of 
Philadelphia;  and  others  in  this  country  and  Europe,  and  the 
writer  takes  pleasure  in  adding  to  their  statements  an  expres- 
sion of  his  belief  in  the  good  that  may  be  accomplished  by  their 
administration,  especially  the  static  wave  and  the  static  induced 
currents.  He  does  not,  however,  believe  it  justifiable  to  rely 


1 68  Tlierapeutics  of  Dry  Hot  Air. 

upon  them  or  any  other  one  remedial  agent  to  the  exclusion 
of  others  that  promise  to  influence  the  disease  process  happily. 
He  believes  that  much  quicker  and  better  results  can  be  ob- 
tained by  combining  several  means  of  benefit  than  by  the  use 
of  any  one  alone,,  and  in  a  disease  of  such  gravity  and  general 
intractability  it  is  certainly  wise  to  give  the  patient  the  benefit 
of  everything  known  to  be  helpful  in  bringing  about  the 
restoration  of  health. 

The  remarks  in  the  section  upon  "  Intermissions  in  Treat- 
ment "  in  the  chapter  on  "  Technique,"  apply  with  some  force 
to  the  management  of  this  disease.  It  will  usually  be  found 
advantageous  to  treat  the  patient  steadily  for  five  or  six  weeks 
at  first.  The  time  duration  of  subsequent  courses,  and  of  the 
intervals  between  them,  will  be  governed  by  the  effect  produced 
in  the  individual  cases. 

In  concluding  this  subject,  it  will  not  be  amiss  to  call  atten- 
tion to  the  fact  that  "  Eternal  vigilance  is  the  price  of  safety." 
While  many  patients  are  apparently  cured  by  the  use  of  the 
above-described  remedial  measures,  yet  the  majority  are  merely 
improved  to  such  an  extent  that  by  the  conscientious  exercise 
of  unremitting  care  they  may  live  for  years  in  good  health  and 
practically  unimpaired  usefulness ;  a  little  neglect  as  regards 
diet,  exposures,  or  over-exertion,  however,  is  sometimes 
sufficient  to  bring  on  an  exacerbation,  and  force  the  patient 
to  undergo  another  course  of  active  treatment.  There  are  few 
diseases  in  which  an  eternal  exercise  of  caution  and  judgment 
are  so  necessary  to  the  continuance  of  the  victim's  life,  health, 
and  comfort,  as  in  the  one  which  we  have  just  been  consider- 
ing. 


CHAPTER   IX. 
ARTHRITIS  DEFORMANS. 

Modifications  of  Clinical  Conditions 
producible  with  Dry  Hot  Air. 

Local  Application. 

This  measure  sometimes  exhibits  considerable  efficacy  as  a 
pain-relieving  agent,  and  in  rare  cases  appears  to  exercise  some 
positively  curative  influence;  as  a  rule,  hoivever,  it  does  not 
enter  largely  into  the  management  of  the  disease. 

General  Application. 

First,  temporary  mitigation  of  pain  frequently  and  a  sedative 
influence  upon  the  nervous  system,  which  increases  the  amount 
of  sleep  and  quietude  procurable,  hence  conduces  to  invigora- 
tion  of  the  nerve  centers. 

Second,  increased  oxidation  of  waste  material  and  accelera- 
tion of  the  process  of  its  elimination  through  the  skin,  lungs, 
and  kidneys,  thereby  relieving  the  already  depressed  nervous 
functions  from  the  further  depression  which  would  be  induced 
by  the  retention  of  sub-oxidation  products  in  the  body. 

Third,  an  influence  upon  the  nervous  system  as  a  whole  and 
upon  general  metabolism,  which  is  in  the  line  of  a  stimulation  of 
physiological  repair  and  normal  function,  hence  is  not  followed 
by  evil  reactionary  effects  when  judiciously  administered,  and 
results  in  a  hastening  of  the  process  of  recovery  of  impaired 
structures. 

Fourth,  the  restoration  to  usefulness  and  comfort  of  a  large 
proportion  of  the  victims  of  this  disease,  who,  without  it,  would 
be  doomed  to  a  painful  life  of  hopeless  and  helpless  crippledom. 

RATIONALE  OF  THERMOTHERAPY. 

It  has  always  been  our  contention  that  if  dry  hot  air  did 
nothing  but  relieve  the  agonizing-  pain  of  acute  rheumatism, 

169 


170  Therapeutics  of  Dry  Hot  Air. 

it  would  be  entitled  to  a  place  in  the  highest  rank  of  therapeu- 
tical agents.  We  have  seen  that  it  not  only  does  this,  but  that 
it  lessens,  by  a  large  percentage,  the  duration  of  the  disease, 
and  transforms  rheumatism  from  one  of  the  most  obstinate 
into  one  of  the  most  tractable  of  ailments.  In  arthritis  defor- 
mans  we  are  again  struck  by  the  claim  which  it  imposes  upon 
our  respect,  because  of  the  power  which  it  exhibits  of  rendering 
useful  and  comfortable  many  lives  which  would  otherwise 
be  spent  in  hopeless  and  helpless  misery.  This  disease  has  been 
hitherto,  and  is  now,  under  ordinary  management,  the  bete 
noire  of  the  profession. 

The  correct  diagnosis  of  this  ailment,  from  a  therapeutical 
standpoint,  is  of  the  utmost  importance,  because  it  is  one  of 
those  affections  in  which  the  treatment  of  conditions  closely 
resembling  it  clinically  is  usually  ineffective  and  sometimes 
positively  harmful.  If  the  victims  of  arthritis  deformans  are 
brought  under  an  appropriate  line  of  management  at  a  moder- 
ately early  stage,  the  great  majority  of  them  can  be  restored 
to  useful  and  comfortable  lives,  and  a  large  proportion  can  be 
restored  to  apparently  perfect  health,  whereas,  if  the  disease 
is  unrecognized,  hence  improperly  treated  for  months  or  years, 
organic  changes  will  take  place  in  the  structures  involved 
of  such  a  nature  and  degree  as  will  render  utterly  impossible 
the  restoration  of  normal  function.  Because  of  these  facts, 
I  shall  touch  briefly  upon  some  aspects  of  the  problem  that  do 
not  come  strictly  within  the  scope  of  this  work. 

Etiology  and  Pathology. 

Nothing  conclusive  can  be  said  as  to  the  primary  etiology 
of  this  disease ;  some  observers  believe  a  micro-organism  to  be 
responsible ;  others  that  it  is  a  disorder  of  general  metabolism ; 
and  still  others  that  it  is  some  disorder  of  the  central  or  sym- 
pathetic nervous  systems  whereby  the  trophic  functions  of  the 
nerves  supplying  the  parts  affected,  or  of  the  centers  con- 
trolling these  nerves,  are  impaired.  Those  maintaining  the 
last-named  hypothesis  seem  to  be  in  the  majority  at 
present. 

Neural  Theory. — Among  the  most  prominent  reasons  for 


Arthritis  Deformans.  171 

considering  it  to  be  of  neural  origin  may  be  mentioned  the 
following : 

First,  its  most  constant  lesions,  viz.,  dystrophy  of  the  joint 
cartilages  and  articular  portions  of  the  bones,  the  pigmentation 
and  textural  changes  in  the  skin,  and  the  atrophy  of  the  muscles 
controlling  the  affected  joints,  are  all  of  a  tropho-neurotic 
character. 

Second,  it  rarely,  if  ever,  occurs  in  an  individual  who  is  not 
of  a  neurotic  tendency,  or  debilitated  by  some  excessive  nerve 
strain  or  depressing  illness,  as  la  grippe,  typhoid  fever,  nervous 
exhaustion,  etc.,  or  constitutionally  weakened  by  some  diathesis 
(tuberculous,  lithaemic,  or  otherwise). 

Third,  lesions,  at  least  of  the  joints,  anatomically  identical 
with  those  encountered  here,  are  also  met  with  in  some  degen- 
erative diseases  of  the  spinal  nerve  tracts — as  tabes,  for  in- 
stance. 

Fourth,  the  joint  lesions  usually  occur  more  or  less  sym- 
metrically on  both  sides  of  the  body. 

Fifth,  local  measures  exclusively,  very  rarely  accomplish 
anything  but  temporary  relief  of  pain,  while  measures  ad- 
dressed to  the  nerve  centers  themselves  accomplish  a  great 
deal  in  the  way  of  permanent  cure. 

Sixth,  the  disease  is  nearly  always  accompanied  by  marked 
evidences  of  impairment  of  function  of  the  sympathetic  nerve 
centers,  for  the  explanation  of  which  the  presence  of  pain 
and  its  direct  or  remote  effects,  in  the  localities  and  of  the 
nature  and  severity  of  that  accompanying  arthritis  deformans, 
is  not  always  sufficient. 

Another  fact  which  may  be  looked  upon  as  possessing  some 
significance  in  this  connection  is  that  in  some  cases  the  improve- 
ment under  treatment  in  the  general  condition  will  be  marked, 
but  the  local  lesions  will  show  no  signs  of  permanent  gain  for 
several  weeks.  This  might  be  due  to  the  fact  that  the  local 
lesions  are  dependent  upon  trophic  impairment  of  the  central 
nervous  system,  and  that  they  will  not  improve  until  these 
centers,  which  control  their  nutrition,  have  been  brought  to  a 
state  of  efficient  action.  While  this  result  was  being  obtained, 
the  local  lesions  would  be  expected  to  remain  in  statu  quo. 


1 72  Therapeutics  of  Dry  Hot  A  ir. 

It  must  be  admitted  that  much  of  the  available  evidence 
points  strongly  to  the  conclusion  that  the  disease  is  not  pri- 
marily local. 

Rheumatism  as  a  Causative  Factor. — It  is  not  at  all  prob- 
able that  the  disease  is  "  rheumatic  "  in  its  nature,  although  an 
acute  attack  of  rheumatism  in  one  whose  nervous  system  is 
predisposed  may  precipitate  the  disease.  We  have  personally 
had  several  such  cases  under  observation.  When  such  a  case 
is  encountered  before  the  active  rheumatic  influence  has  sub- 
sided, and  if  the  trophic  functions  have  not  been  too  much  im- 
paired to  recover  their  equilibrium  upon  removal  of  the  exciting 
cause,  anti-rheumatic  treatment  will  frequently  cure  the  ar- 
thritis deformans  by  removing  the  rheumatism  which  had  set 
up  and  was  keeping  up  the  trouble.  If  the  predisposition  to  the 
disease  is  constituted  by  the  lithsemic  or  gouty  diathesis,  as  I  be- 
lieve it  occasionally  is,  then  iodide  of  potassium,  colchicum,  or 
other  drugs  of  a  like  nature  will  always  benefit,  and  sometimes 
cure,  the  affection.  But  when  the  disease  is  not  dependent 
upon,  or  precipitated  by,  a  pathological  condition  amenable  to 
what  we  look  upon  as  specific  medication,  nothing  benefits  it  in 
the  least  except  measures  directed  towards  improvement  of  the 
general  metabolic  functions  and  anti-rheumatic  or  anti-lith- 
aemic  remedies  sometimes  cause  an  increase  in  the  intensity  of 
the  symptoms. 

"  Uric  acid "  may  be  ruled  out  absolutely  as  a  causative 
factor.  Its  presence  or  absence,  excess  or  deficiency,  have  noth- 
ing whatever  to  do  with  this  problem. 

If  it  is  a  disorder  of  general  metabolism,  or  of  the  sympa- 
thetic nervous  system,  then  it  follows  that  all  nerve  debilities — 
neurasthenia,  hysteria,  etc. — are  not  necessarily  so  devoid  of 
evil  tendencies  as  has  been  generally  believed,  and  that 
thorough  and  efficient  treatment  of  the  same  should  be  insti- 
tuted as  soon  as  they  come  under  observation,  and  persevered 
in  until  they  are  removed.  It  is  probable  that,  when  this  plan 
of  dealing  with  the  so-called  functional  disturbances  of  the 
nervous  system  is  uniformly  adopted,  we  shall  encounter  ar- 
thritis deformans  and  some  other  grave  constitutional  diseases 
less  frequently. 


Arthritis  Deformans.  173 

Symptomatology. 

The  most  important  symptomatic  phenomena  accompanying 
the  disease  are  as  follow  : 

First,  pain. 

Second,  elevation  of  body  temperature. 

Third,  general  nervous  debility. 

Fourth,  atrophy  of  the  musculature  controlling  the  affected 
joints. 

Fifth,  spasm  of  these  muscles. 

Sixth,  textural  changes  in  the  skin. 

Seventh,  pigmentation  of  the  skin. 

Eighth,  a  slight  degree  of  albuminuria. 

Ninth,  a  varying  degree  of  general  systemic  toxaemia. 

Pain. — The  pain  is  of  two  varieties;  that  in  the  joint  itself 
ordinarily  described  by  the  patient  as  "  boring,"  "  grinding,"  or 
"  aching  "  in  character  when  the  joint  is  at  rest,  and  as  an 
excruciating  "  soreness  "  when  the  member  is  manipulated ; 
and  that  in  the  nerve  trunks  from  which  the  joint  and  its 
musculature  are  innervated. 

The  first  mentioned  is  usually  constantly  present  in  the 
acute  stage.  At  any  stage  it  is  increased  by  movement,  or  by 
sharply  bringing  the  affected  articular  surfaces  together,  as 
by  tapping  sharply  and  suddenly  the  bottom  of  the  heel  of  the 
extended  leg  when  the  hip  is  affected.  Palpation  of  the 
affected  joint  provokes  pain,  and  the  firmer  the  pressure  the 
greater  the  pain  induced.  Occasionally  a  case  is  encountered, 
especially  in  old  patients,  wherein  no  pain  of  any  sort  is 
present  while  the  affected  member  is  at  rest,  but  it  is  always 
provoked  by  motion. 

The  pain  in  the  nerve  trunks  is  paroxysmal,  nearly  always 
worse  at  night,  and  there  is  usually  present  in  acute  cases  a 
constant,  dull,  aching  soreness.  A  certain  proportion  of  the 
aching  soreness  is  probably  due  to  pressure  upon  the  nerve 
trunks  from  tonic  spasm,  which  is  frequently  present  in  the 
muscles  controlling  affected  joints.  Portions  of  the  nerve  are 
usually  sensitive  to  pressure,  as  in  ordinary  neuralgias. 

A  characteristic  feature  of  the  pain  when  the  hip  joint  is 


1 74  Therapeutics  of  Dry  Hot  A  ir. 

involved  is  that  it  appears  in  the  groin  as  well  as  in  the  hip. 
This  peculiarity  is  very  common  in  arthritis  deformans,  and 
very  rare  in  most  other  affections  of  this  joint,  from  which  it 
would  have  to  be  differentiated. 

Another  characteristic  sign  when  the  hip  is  involved  is 
inability  to  cross  the  leg  on  the  affected  side  over  the  opposite 
knee,  when  in  the  sitting  posture,  without  lifting  the  member 
with  the  hand.  This  phenomenon  is  dependent  largely,  if  not 
entirely,  upon  reflex  inhibition  of  muscle  function  due  to  the 
progressively  increasing  pain  caused  by  this  particular  move- 
ment of  the  joint. 

Body  Temperature. — The  elevation  of  temperature  varies 
from  half  a  degree  to  two  degrees  Fahrenheit  above  the  nor- 
mal, very  rarely  more,  and  presents  a  very  constant  general 
curve,  being  below  normal  in  the  morning,  beginning  to  rise 
about  eleven  or  twelve  o'clock,  and  reaching  its  maximum  in 
the  early  evening.  In  severe,  acute  cases,  especially  in  young 
patients,  it  sometimes  reaches  102.5°  F.,  but  we  have  never 
seen  an  uncomplicated  case  in  which  it  went  above  that  point. 

It  will  be  observed  that  this  resembles  the  temperature  curve 
characteristic  of  some  other  diseases,  notably  tuberculosis,  and 
it  is  not  always  the  easiest  thing  in  the  world  to  differentiate 
mono-articular  arthritis  deformans  from  joint  tuberculosis  at 
the  first  visit.  As  a  rule,  however,  the  temperature  of  tubercu- 
losis runs  higher  than  that  of  arthritis  deformans,  its  curve  is 
more  irregular,  and  it  reaches  its  maximum  elevation  earlier 
in  the  day.  In  doubtful  cases  the  development  of  other  charac- 
teristic signs  will  soon  settle  the  question. 

Nervous  System. — The  nervous  debility  does  not  differ 
from  that  due  to  other  causes,  except  in  its  profoundly  trophic 
character,  and  can  always  be  demonstrated  as  having  pre- 
ceded by  some  weeks  or  months  the  development  of  the  char- 
acteristic symptom  complex.  The  tendon  reflexes  are  some- 
what increased  usually ;  the  secretions  of  the  digestive  ferment- 
producing  glands  are  impaired,  and  departures  from  the  nor- 
mal, both  gastric  and  intestinal,  are  in  evidence.  Sleeplessness, 
sometimes  from  pain,  but  also  sometimes  from  pure  irritability 
of  the  cerebral  centers,  is  occasionally  a  troublesome  symptom. 


Arthritis  Deformans.  175 

As  a  rule,  however,  patients  nap  sufficiently  during  the  day  to 
make  up  for  what  they  lose  during  the  night. 

Muscular  Atrophy. — Atrophy  of  the  muscles  controlling 
the  joint  is  a  very  constant  phenomenon,  and  is  usually  accom- 
panied by  tenderness  of  the  same  upon  pressure,  as  in  pinch- 
ing. Impairment  of  function  is  present  in  variable  degree, 
which,  in  many  cases,  presents  a  characteristic  also  met  with 
in  rheumatism,  viz.,  the  muscles  can  be  contracted  up  to  a 
certain  point,  when  further  movement  ceases  sharply  and  sud- 
denly as  if  the  joint  were  hung  on  a  ratchet.  In  other  cases  it 
consists  of  simple  weakness,  and  in  still  others  of  a  reflex  inhi- 
bition of  function  from  the  pain  in  the  joint  which  movement 
excites. 

Muscular  Spasm. — A  frequent  cause  of  pain  in  cases  where 
the  larger  joints  are  affected  is  spasm  of  the  controlling  mus- 
culature occurring  during  sleep.  As  soon  as  the  patient  relaxes 
into  sound  slumber  he  is  awakened  by  excruciating  pain,  and 
finds  the  affected  muscles  strongly  contracted.  This  condition 
is  sometimes  sufficiently  persistent  to  prevent  securing  the 
necessary  amount  of  sleep,  and  the  victim  becomes  so  fearful 
of  the  agony  of  the  awakening  that  he  is  afraid  to  attempt  it. 

When  the  cervical  vertebrae  are  involved,  profound,  per- 
sistent, and  very  painful  torticollis  may  be  produced,  and  some- 
times this  condition  may  remain  for  years  after  all  other  signs 
of  the  disease  have  disappeared. 

When  the  maxillary  articulation  is  affected  masseteric  spasm 
is  frequently  a  very  troublesome  factor;  I  once  had  a  patient 
affected  with  such  a  lockjaw,  whom  I  was  obliged  to  feed  upon 
liquids  only,  through  his  teeth,  for  two  weeks.  More  or  less 
limitation  of  the  masticatory  movements  is  always  present  when 
this  joint  is  affected.  Involvement  of  this  joint,  by  the  way, 
is  a  very  characteristic  phenomenon  in  this  disease;  it  occurs 
with  the  utmost  rarity  in  other  diseases  from  which  it  might 
be  necessary  to  differentiate  arthritis  deformans. 

Persistent  muscular  contractures,  such  as  accompany  cere- 
bral paralysis,  are  present  in  many  cases  exhibiting  severe 
acute  features,  and  in  most  of  the  old  chronic  cases. 

Skin. — The  textural  changes  sometimes  resemble  the  "  glossy 


176  Therapeutics  of  Dry  Hot  Air. 

skin  "  seen  in  many  cases  of  impairment  of  the  function  of 
peripheral  nerves ;  sometimes  the  affected  area  does  not  exhibit 
any  difference  in  color  from  that  of  the  normal  integument,  but 
it  has  a  peculiar  dry,  smooth,  soft  look  and  feel,  like  satin. 

Cases  are  also  met  with  in  which  the  skin  about  the  lesions, 
and  sometimes  over  the  whole  body,  looks  and  feels  greasy  and 
is  covered  with  perspiration  almost  constantly;  which  condi- 
tion is  also  encountered  in  other  tropho-neuroses. 

The  characteristic  pigmentation  of  the  skin  occurs  as 
maculae,  varying  in  size  from  that  of  the  head  of  a  pin  to  that 
of  a  quarter  of  a  dollar,  the  small  sizes  predominating.  They 
are  irregular  as  to  outline  and  resemble  the  freckles  seen  upon 
elderly  people,  or  "  liver  spots,"  more  than  anything  else.  They 
differ  from  these,  however,  in  possessing  a  characteristic  yel- 
lowish-brown, dirty  look,  which  is  usually  distinguishable  to 
an  experienced  observer,  and  also  in  that  they  are  not  confined 
to  those  parts  of  the  body  which  are  habitually  exposed  to  the 
light,  as  is  the  case  with  true  freckles.  They  usually  are  most 
in  evidence  on  those  portions  of  the  skin  contiguous  to  the 
affected  joints,  but  may  frequently  be  found  also  upon  remote 
parts  of  the  body,  particularly  the  back,  abdomen,  extensor 
surfaces  of  the  limbs,  and  about  the  clavicular  regions. 

We  have  rarely  failed  to  find  this  peculiar  pigmentation 
present  to  some  extent  in  this  disease,  and  although  it  is  fre- 
quently present  in  individuals  who  are  not  so  afflicted,  yet  we 
have  come  to  regard  it,  when  taken  in  connection  with  other 
symptoms,  as  one  of  the  most  valuable  of  the  differential 
signs. 

Albuminuria. — The  urine  of  arthritis  deformans  very  fre- 
quently contains  a  trace  of  albumin,  probably  due  to  renal  irri- 
tation from  excretion  of  products  of  faulty  metabolism  as  it 
usually  rapidly  disappears  under  body  dry  hot  air  treatments. 

We  have  never  observed  casts  in  uncomplicated  cases. 

Joint  Appearances. — Nothing  has  been  said  about  the  ex- 
ternal appearances  of  affected  joints,  because  they  do  not 
possess  any  value  as  differential  signs  in  those  cases  where 
differential  signs  are  most  needed.  One  or  more  may  be  in- 
volved, the  swelling  may  be  diffuse  or  nodular,  the  skin  over 


Arthritis  Deformans.  177 

them  may  be  shiny  or  dull,  red,  or  devoid  of  any  indication  of 
inflammatory  action.  We  have  simply  a  pathological  joint, 
any  of  the  appearances  of  which  may  be  duplicated  by  several 
other  affections,  and  when  these  other  affections  enter  the  diag- 
nostic problem  it  is  invariably  necessary  to  go  outside  of  the 
external  appearances  of  the  joint  for  the  decisive  information. 
The  same  statement  as  to  external  appearances  applies  to  the 
persistent  muscular  contractures. 

DIAGNOSIS. 

Symptomatology. — At  the  present  time,  unfortunately,  this 
disease  is  more  frequently  overlooked  and  miscalled  than 
probably  any  other  to  which  flesh  is  heir.  This  is  due  to  the 
fact  that  it  has  only  very  recently  been  recognized  as  a  distinct 
disease  entity,  which  has  prevented  the  constant  and  character- 
istic symptoms  from  being  studied  and  grouped  so  as  to  make 
it  recognizable  by  physicians  at  large,  and  to  the  additional 
fact  that  it  has  hitherto  been  almost  absolutely  intractable  to 
all  known  treatment,  which  has  discouraged  attempts  at  differ- 
entiation because  of  the  apparent  uselessness  of  the  result,  if 
attained.  The  therapeutical  development  of  dry  hot  air  and 
static  electricity,  however,  has  changed  these  conditions,  and 
rendered  the  attainment  of  an  early  diagnosis  of  the  utmost 
importance  to  the  patient. 

It  will  be  observed  from  the  foregoing  that  the  more  promi- 
nent conditions  from  which  arthritis  deformans  is  to  be  differ- 
entiated are  acute  and  chronic  rheumatism ;  chronic  synovitis ; 
flat:foot;  chronic  gouty  conditions;  neuritis;  sometimes  tuber- 
cular and  syphilitic  joint  lesions;  and  when  symptoms  are 
encountered  pointing  to  the  spinal  column  or  hip  joints  as 
affected  by  a  disease  process,  tumors  in  the  thoracic,  abdominal, 
or  pelvic  cavities,  so  situated  as  to  involve  the  nerve  trunks 
and  plexuses  in  these  regions. 

When  the  symptom  complex  is  complete  and  well  developed 
little  difficulty  is  experienced  by  those  who  have  seen  much  of 
the  disease,  but  it  not  infrequently  exhibits  a  reluctance  to  so 
betray  itself,  especially  in  the  early  stages  of  the  attack. 

There  are  two  conditions  met  with  in  early  cases,  which  may 


1 78  Therapeutics  of  Dry  Hot  A  ir. 

be  looked  upon  as  almost  positively  characteristic  when 
occurring  in  connection  with  acute  inflammatory  joint  condi- 
tions, viz.,  involvement  of  the  maxillary  articulation,  and  a 
greater  or  less  degree  of  persistent  torticollis;  these  phe- 
nomena occur  with  the  greatest  rarity  in  other  conditions 
from  which  it  might'  be  necessary  to  differentiate  arthritis 
deformans. 

A  history  of  repeated  attacks  is  of  considerable  significance. 

If  the  joint  involved  is  the  hip,  reflection  of  the  pain  into  the 
groin,  exacerbation  of  the  pain  by  pressing  inward  upon  the 
trochanter,  or  by  sharply  tapping  the  bottom  of  the  heel  of  the 
extended  leg,  and  inability  to  cross  the  leg  upon  the  affected 
side  over  the  opposite  knee,  when  in  the  sitting  position,  with- 
out lifting  the  member  with  the  hand,  form  a  combination  of 
symptoms  which  is  practically  conclusive,  in  the  absence  of 
well-known  clinical  signs  of  the  other  resembling  conditions, 
and  this  combination  is  almost  invariably  present  in  arthritis 
deformans  of  this  joint. 

After  an  attack  has  existed  for  some  weeks  the  characteristic 
muscular  contractions  and  atrophy,  glossy  skin,  and  other  signs 
previously  mentioned,  combine  to  form  a  picture  which  is 
hardly  mistakable  for  anything  else. 

The  Roentgen  Ray. — X-light  is  a  very  useful  diagnostic 
agent  in  doubtful  cases  of  some  standing.  By  it  can  be  deter- 
mined absence  of  cartilages  which  have  been  absorbed,  a  char- 
acteristic lesion  of  the  disease  when  taken  in  connection  with 
other  symptoms  and  by  reason  of  which  the  bony  surfaces  are 
closely  approximated ;  a  very  different  picture  from  that  which 
obtains  in  healthy  joints  (Cuts  XXIV,  XXV,  and  XXVI). 
Osteophytes,  when  present,  are  observable  by  this  means,  and 
bony  anchylosis  is  usually  differentiable  from  the  fibrous 
variety,  except  when  the  hip  or  the  vertebrae  are  in  question ; 
even  then  its  answer  is  sometimes  conclusive. 

Occasionally  it  is  only  by  a  process  of  careful  exclusion  and 
the  closest  scrutiny  of  the  history  of  the  case  that  a  correct 
diagnosis  can  be  reached.  It  can  be  reached,  however,  posi- 
tively, satisfactorily,  and  at  once,  in  nine  cases  out  of  ten,  and 
no  pains  should  be  spared  to  secure  this  end,  in  view  of  the 


. 

a  »q 

eo    n> 
0*. 

2,  ° 

O    <— i 

«   ° 
3  5' 


OQ 


Arthritis  De for  mans. 


181 


fact  that  the  disease  is  no  longer  to  be  classed  with  those  that 
are  not  amenable  to  treatment. 

Inconstancy  of  Symptom  Complex.— We  will  close  this 
brief  section  upon  the  exceedingly  important  problem  of  diag- 
nosis by  calling  attention  to  the  following  additional  facts 
which  bear  upon  this  point. 

Although  in  the  commonest  form  of  the  disease,  which  occurs 
almost  exclusively  in  patients  over  forty,  the  small  joints  are 


XXVI. — Arthritis  Deformans  of  the  Knee  (from  a  radiographic  stand- 
point the  position  of  the  joint  is  faulty,  but  the  plate  illustrates 
very  well  absorption  of  the  joint  cartilage  ;  in  radiographs  of  the 
normal  knee  the  presence  of  these  cartilages  causes  a  large  clear 
space  to  intervene  between  the  patella  and  the  articular  surface  of 
the  femur  anteriorly  ;  in  advanced  arthritis  deformans  of  this  joint 
the  patella  appears  to  rest  directly  upon  the  femur  as  above  shown). 

first  attacked,  and  the  lesions  are  nearly  always  bilateral,  yet 
this  is  not  necessarily  the  case  in  all  forms  of  the  trouble.  An 
attack  may  commence  in  the  larger  joints,  run  its  course,  and 


1 82  Therapeutics  of  Dry  Hot  Air. 

recover  without  having  involved  the  smaller  joints  at  all;  or 
it  may  be  confined  entirely  to  one  large  joint,  as  the  hip  for 
instance.  Some  of  the  severest  cases  are  of  this  character. 

While  the  onset  is  usually  gradual,  with  a  beginning  so 
insidious  that  the  patient  is  not  aware  that  anything  is  wrong 
until  a  wrench  calls  his  attention  to  the  sensitive  member,  yet 
it  may  develop  as  suddenly  as  acute  articular  rheumatism,  and 
lay  the  patient  helpless  upon  his  bed  in  a  night. 

When  the  disease  attacks  a  person  under  thirty  years  of  age, 
it  usually  involves  both  large  and  small  articulations,  and  in 
these  cases  the  worse  phases  of  the  disease  and  those  most 
resistant  to  treatment  are  encountered. 

Therapeutic  Indications. — The  objects  of  treatment  deduci- 
ble  from  the  foregoing  would  be  as  follow : 

First,  to  relieve  pain. 

Second,  to  increase  the  efficiency  of  the  trophic  functions, 
and  maintain  the  general  nervous  system  of  the  patient  in  as 
good  a  condition  as  possible. 

Third,  to  clear  the  system  of  sub-oxidation  products. 

Fourth,  to  relieve  joint  disability. 

Local  Application. — As  this  disease  is  not  of  local  origin 
it  would  hardly  be  expected  that  this  measure  would  exercise 
any  positively  curative  power  in  uncomplicated  cases,  and  our 
personal  experience  with  it  has  led  us  to  conclude  that  this 
inference  is  correct.  I  have  never  seen  but  one  case  in  which 
curative  effects  could  justly  be  attributed  to  it,  and  it  was  ulti- 
mately necessary  to  call  upon  the  body  treatment  in  this  case 
before  it  could  be  brought  to  a  successful  termination. 

Its  power  to  relieve  local  stasis  of  the  body  fluids  and  to 
effect  sedation  of  nerve  tissue  sometimes  causes  it  to  be  very 
useful  as  a  pain-relieving  agent,  and  occasionally  it  performs 
this  function  better  than  anything  else.  Its  possible  efficiency 
in  any  given  case  can  be  ascertained  only  by  trial. 

General  Application. — In  our  opinion,  the  body  dry  hot  air 
application  is  to-day  the  sheet  anchor  of  hope  in  the  manage- 
ment of  arthritis  deformans,  because  through  it  is  obtainable 
in  largest  degree  the  stimulant  influence  upon  the  trophic  nerve 
centers  and  general  metabolism  which  constitute  the  curative 


Arthritis  Deformans.  183 

element.  Its  physiological  action,  as  will  be  recalled,  may  be 
summarized  as  follows:  first,  it  produces  an  immediate  and 
powerful  stimulation  of  the  vital  physical  signs ;  second,  a  reflex 
stimulation  of  the  functions  of  all  the  organs  and  tissues  of  the 
body,  resulting  in,  first,  a  degree  of  elimination  of  urea  and 
other  excreta  which  is  probably  unequaled  by  that  producible 
with  any  other  measure  now  known,  and  second,  an  amount  of 
reconstructive  activity  which  would  appear  also  to  be  in  excess 
of  that  derivable  from  the  use  of  other  agents. 

Ample  logical  indication  for  its  employment  is  found  when 
we  consider  these  influences  in  connection  with  the  therapeutic 
indications  noted  above.  .  There  is  usually  present,  first,  a 
notable  depression  of  the  vital  physical  phenomena;  second, 
impairment  of  function  of  many  of  the  organs  concerned  in  the 
digestive,  elaborative,  and  assimilative  processes  of  the  body; 
and  third,  a  marked  deficiency  in  the  reconstructive  activities; 
the  inferences  suggested  by  the  foregoing  have  been  fairly 
well  borne  out  by  practical  results  accruing  in  actual  ex- 
perience. 

ILLUSTRATIVE  CASES. 

That  form  of  the  disease  which  affects  the  smaller  joints  is 
common  enough  and  familiar  enough  not  to  require  illustra- 
tion, but  the  following  case  exemplifies  very  well  the  variety 
which  involves  the  larger  joints,  as  regards  clinical  character- 
istics and  response  to  treatment  with  dry  hot  air. 

Mrs.  E.  L.  P.,  aged  sixty-two  years,  consulted  me  on  May 
14,  1900.  She  had  noticed  a  soreness  coming  on  after  walking, 
just  below  the  crest  of  the  right  ilium,  four  months  previously, 
which  soreness  had  grown  rapidly  worse  for  two  months,  by 
which  time  it  had  extended  so  that  it  involved  the  front  and 
inner  aspects  of  the  thigh  as  far  down  as  the  knee.  It  had 
continued  to  increase,  both  as  to  severity  and  extent  of  area 
involved,  until  at  the  time  of  her  consultation  with  me  the  pain 
was  present  in  the  hip,  groin,  and  front  and  inner  aspects  of  the 
thigh,  and  streaked  down  below  the  heel  along  the  posterior 
aspect  of  the  leg;  her  condition  as  regards  pain  and  ability 
to  move  about  was  pitiable  in  the  extreme.  Was  sleeping  very 
poorly  because  of  pain  and  muscular  spasm  in  her  thigh  which 
awakened  her  frequently  during  the  night.  Suffered  fre- 


184  Therapeutics  of  Dry  Hot  Air. 

quently  from  hot  flashes  and  formications  irregularly  dis- 
tributed over  the  body.  Appetite  was  fair  and  bowels  regular. 

She  was  markedly  neurasthenic,  and  had  been  so  since 
passing  the  climacteric  twenty  years  previously.  At  this 
time  she  had  also  suffered  quite  severely  from  asthma,  but  this 
had  disappeared  after  a  stay  in  another  city,  and  had  never 
returned.  There  was  no  history  of  injury.  Mouth  tempera- 
ture had  ranged  from  97°  F.,  in  the  morning,  to  99.6°  F.,  at 
night.  The  extensor  muscles  of  the  thigh  on  the  affected  side 
had  been  somewhat  stiff  and  sore  upon  pressure  for  the  pre- 
ceding ten  months,  but  she  had  not  paid  much  attention  to  the 
matter  until  the  acute  and  constant  pain  had  drawn  her  atten- 
tion to  the  development  of  the  disability.  Had  been  treated  for 
rheumatism  up  to  this  time,  but  without  beneficial  results. 

Her  mother  had  died  of  consumption,  and  maternal  grand- 
father was  supposed  to  have  died  from  it.  She  was  one  of  a 
family  of  eleven  brothers  and  sisters,  seven  of  whom  were 
dead,  and  their  health  histories  and  the  causes  of  death  were 
negative  as  far  as  indicating  hereditary  taint  was  concerned. 
Father  had  died  of  dysentery  at  the  age  of  seventy-three  years. 

Physical  examination  showed  that  the  arcus  senilis  was  well 
developed  and  that  her  radial  arteries  were  atheromatous,  but 
the  heart  sounds  did  not  exhibit  any  abnormality  and  the  lungs 
were  sound.  There  were  no  evidences  of  past  or  present 
disease  in  the  small  joints,  and  no  tenderness  was  present.  She 
was  unable  to  cross  the  right  leg  over  the  left  knee  without 
lifting  it  with  her  hand.  Patellar  reflexes  were  slightly  in- 
creased, especially  on  the  affected  side. 

The  characteristic  pigmentation  of  the  skin  was  present  on 
the  upper  and  outer  aspects  of  the  affected  thigh  and  on  the 
abdomen.  Sensory  phenomena  in  the  skin  covering  the  affected 
thigh  and  leg  were  normal.  Passively  moving  the  hip  joint 
caused  only  a  feeling  of  soreness,  but  smartly  tapping  the 
bottom  of  the  right  heel  with  the  leg  extended  caused  the 
patient  to  cry  out,  and  firmly  pressing  the  head  of  the  femur 
inward  against  the  acetabulum,  or  tapping  it  smartly,  produced 
the  same  result.  The  sciatic  nerve  was  sensitive  to  pressure 
back  of  the  trochanter,  but  nowhere  else,  and  deep  pressure  in 
the  groin  just  outside  of  Poupart's  ligament  elicited  pain.  Her 
urine  contained  a  trace  of  albumin,  but  no  casts. 

It  will  be  noticed  that  the  characteristic  signs  of  arthritis 
deformans  of  the  hip  joint  were  present,  viz.,  inability  to  cross 
the  affected  limb  over  the  opposite  one  unaided,  while  in  a 
sitting  position ;  pain  in  the  hip  reflected  into  the  groin ;  pain 
upon  pressing  the  head  of  the  femur  sharply  and  firmly  against 
the  acetabulum  :  the  characteristic  pigment  spots  in  the  skin. 


A  rth  rit  is  De for  mans.  1 8  5 

and  the  typical  slight  elevation  of  temperature  with  a  regular 
course.  The  diagnosis  lay  between  pelvic  neoplasm  involving 
the  sacral  plexus  or  its  branches,  which  was  ruled  out  by 
physical  examination  and  the  clinical  signs;  sciatic  neuritis, 
which  was  excluded  by  the  absence  of  sensory  disturbances  in 
the  distribution  of  the  nerve,  and  the  fact  that  stretching  it  by 
flexing  the  thigh  upon  the  body  did  not  produce  pain  until  the 
hip  joint  began  to  be  strained;  and  tuberculosis  of  the  joint. 
The  decided  localization  of  the  intensity  of  the  pain  in  the  hip 
joint,  together  with  the  characteristic  symptoms  noted  above, 
were  amply  sufficient  for  decision  in  favor  of  mon-articular 
arthritis  deformans,  and  I  made  this  diagnosis. 

She  was  admitted  to  the  sanitarium  for  treatment  May  15, 
1900,  four  months  after  the  acute  trouble  started.  She  was 
treated  with  the  current  from  the  high  tension  coil  through 
the  joint  that  evening,  with  resulting  marked  remission  of 
pain,  but  she  did  not  sleep  well  because  of  nervous  irritability 
and  muscular  spasms  in  the  affected  thigh,  which  awakened  her 
several  times.  The  next  day  she  was  given  a  body  dry  hot  air 
treatment,  which  did  away  with  the  pain  entirely  while  she 
was  in  the  apparatus,  but  it  returned  sharply  an  hour  after- 
ward. This  was  repeated  every  day  the  first  week,  and  every 
other  day  the  second  week.  Local  dry  hot  air  treatments  failed 
to  relieve  the  pain  effectually,  so  they  were  abandoned  and  the 
current  from  the  high-tension  coil,  which  performed  this  office 
better  than  anything  else,  was  substituted  at  least  once,  and 
sometimes  twice,  daily. 

During  the  night  of  May  i8th,  she  slept  uninterruptedly  all 
night,  something  she  had  not  done  before  in  many  weeks,  and 
she  continued  to  sleep  very  well  thereafter.  The  next  day  it 
was  noticed  that  her  limp  was  diminishing.  On  May  2ist  it 
was  observed  that  the  arteries  at  the  wrist  were  growing 
softer  and  more  elastic,  and,  to  dispose  of  this  matter  for 
good,  I  will  say  here  that  when  she  was  discharged  at  the  end 
of  three  months,  I  was  unable  to  observe  that  any  atheroma 
was  left.  Finally,  in  this  connection,  I  will  state  that  a  large 
number  of  cases  of  atheroma,  at  least  in  vessels  susceptible  of 
palpation,  respond  to  body  dry  hot  air  treatments  in  this 
manner.  It  is  not  usual  for  the  condition  to  disappear  so 
entirely,  however. 

At  the  end  of  two  weeks  she  was  so  far  improved  that  she 
would  be  free  from  pain  for  twenty-four  hours  at  a  time,  and 
could  walk  a  short  distance  without  bringing  on  a  limp.  If 
she  continued  walking,  however,  it  would  provoke  the  old 
soreness. 

I  decided  to  transfer  her  to  the  list  of  out-patients,  and  she 


1 86  Therapeutics  of  Dry  Hot  Air. 

returned  to  the  sanitarium  for  treatment  three  times  weekly 
thereafter  until  August  3,  1900,  when  I  discharged  her  cured. 
At  this  time  she  had  suffered  no  pain  of  any  description  for  two 
weeks.  Her  progress  on  the  whole  had  been  fairly  steady,  but 
there  would  be  periods  of  two  or  three  days  at  a  time  when  her 
pain  and  disability  would  return  upon  her,  as  is  usually  the  case 
with  these  patients.  They  rarely  continue  improving  steadily 
from  day  to  day,  but  have  short  periods  of  improvement,  fol- 
lowed by  periods  of  retrogression,  but  each  period  of  improve- 
ment reaches  a  little  higher  level  than  its  predecessor,  until  the 
trouble  finally  fades  gradually  and  entirely  away. 

I  next  heard  from  this  patient  on  February  18,  1901,  when 
she  called  upon  me  one  afternoon  and  said  that  she  had  felt 
none  of  the  previous  trouble,  until  about  six  weeks  before,  when 
she  had  suffered  from  a  severe  attack  of  la  grippe.  This  had 
been  followed  by  the  old  familiar  pain,  which  was  increasing 
in  intensity,  but  not  in  the  same  place.  It  now  involved  the  left 
hip  and  right  elbow,  and  pigmentation  of  the  skin  was  present 
in  these  regions  and  about  the  clavicles. 

As  the  initiation  of  the  process  was  so  recent,  and  she  was 
able  to  be  about,  I  put  her  vipon  the  out-patient  list,  and  she 
came  to  the  sanitarium  for  a  body  treatment,  followed  by  some 
static  modality,  three  times  weekly  for  the  next  two  months. 
The  treatments  were  then  reduced  in  frequency  to  once  a  week 
for  two  months  more,  when  she  was  discharged  cured.  The 
drugs  given  were  the  chloride  of  gold  and  sodium,  arsenic, 
strychnia,  and  occasionally  a  short  course  of  bismuth  sub- 
nitrate  and  peptenzyme  for  slight  attacks  of  indigestion.  I 
have  kept  track  of  her  ever  since,  and  she  has  not  only  had  no 
pain  or  other  evidence  of  her  old  trouble  since  her  last  visit  to 
the  sanitarium,  but  she  has  never  felt  better  in  her  life  than  she 
has  since  then. 

This  case  is  instructive  in  several  ways. 

First,  it  is  an  example  of  pure,  uncomplicated  arthritis  defor- 
mans  in  its  very  early  stages,  and  exhibits  a  beautifully  typical 
symptom  complex  of  the  affection  when  it  occurs  in  the  hip 
joint. 

Second,  it  shows  the  futility  of  anti-rheumatic  treatment  in 
uncomplicated  cases  of  the  disease. 

Third,  it  illustrates  during  the  first  attack  the  power  of  the 
:body  dry  hot  air  application  alone  in  controlling  the  disease,  as 
the  faradism  used  acted  only,  and  was  intended  only,  as  a 
sedative. 


Arthritis  Dtformans.  187 

Fourth,  it  exemplifies  the  power  of  the  body  dry  hot  air  treat- 
ment in  lessening,  and  sometimes  apparently  removing  entirely, 
atheroma  at  least  of  the  palpable  arterial  system. 

Fifth,  it  is  an  example  of  the  influence  of  acute  infectious 
disease  in  precipitating  a  relapse. 

Sixth,  it  exhibits  the  influence  of  the  current  from  the  high 
tension  coil  in  temporarily  alleviating  the  pains  of  the  disease 
when  other  means  are  inefficient.  Usually  the  static  current 
is  the  most  effective  for  this  purpose,  but,  as  has  been  pre- 
viously stated,  faradism  or  the  high  frequency  current  gives 
better  results  in  rare  cases. 

.  There  is  a  tendency  at  the  present  time  to  attempt  a  division 
of  cases  of  arthritis  deformans  into  two  classes ;  those  exhibit- 
ing atrophy  of  the  joint  structures,  and  those  exhibiting  hyper- 
trophy, as  exostoses,  etc.  This  attempt  has  apparently  been 
engendered  by  the  thought  that  these  two  types,  if  they  could 
be  proved  to  exist,  might  be  differentiable  etiologically.  The 
Cases  that  have  so  far  come  under  our  observation  have  not  led 
us  to  believe  that  such  a  classification  is  practicable;  many  of 
them  exhibit  the  typical  atrophy  in  some  joints  and  the  typical 
hypertrophy  in  others  during  the  same  attack.  The  following 
is  a  case  in  point : 

The  patient,  a  telegraph  operator,  thirty  years  old,  came 
under  our  care  for  an  acute  attack  of  the  disease  in  his  shoul- 
ders, wrists,  fingers,  knees,  and  ankles.  Twelve  years  before, 
when  eighteen  years  old,  he  had  been  confined  to  his  bed  for 
several  months  by  the  same  trouble  in  his  hips,  ankles,  and  toes, 
from  which  attack  he  had  recovered. 

At  the  time  he  came  under  our  charge  his  toe  joints  pre- 
sented the  characteristic  atrophic  deformities  much  exagger- 
ated, and  the  pathology  of  the  lesions  was  interestingly  verified 
later,  when  he  had  the  little  toe  of  each  foot  amputated  at  the 
metatarso-phalangeal  articulation,  because  these  members  in 
their  deformed  condition  interfered  with  the  wearing  of  shoes. 
The  articular  ends  of  both  the  phalanx  and  the  metatarsal  bone 
forming  this  joint  were  found  at  the  operation  to  have  been 
absorbed  for  a  distance  of  one  quarter  of  an  inch  upon  each 
bone,  which  accounted  for  his  absolute  inability  to  control  the 
motion  of  his  toes. 

The  point  of  greatest  interest  in  this  connection,  however, 
lies  in  the  fact  that  both  of  his  hips  had  been  completely  anchy- 


1 88  Therapeutics  of  Dry  Hot  A  ir. 

losed  by  the  first  attack ;  this  fact  could  only  be  accounted  for 
upon  the  hypothesis  that  the  so-called  hypertrophic  form  of  the 
disease  had  disabled  these  joints,  or  that  true  bony  anchylosis 
had  supervened,  and  true  bony  anchylosis  is  said  never  to 
develop  in  this  affection. 

This  patient  was  under  treatment  eight  months  before  the 
disease  was  extinguished  from  those  joints  which  were  acutely 
involved  when  he  came  to  us,  and  no  change,  of  course,  took 
place  in  the  original  seats  of  the  process. 

TREATMENT. 

It  is  only  within  a  very  few  years  that  systematic  efforts  to 
evolve  a  special  therapy  for  this  disease  have  been  attempted, 
largely  because,  as  already  stated,  it  has  been  only  a  few  years 
since  our  knowledge  of  the  affection  has  been  sufficient  to 
render  possible  a  positive  diagnostic  differentiation  in  a  large 
proportion  of  cases.  For  this  reason  text-book  literature  upon 
its  therapeutics  is  meager  and  very  unsatisfactory  when  sub- 
jected to  the  test  of  clinical  application,  about  all  that  can  be 
gleaned  from  it  being  a  recommendation  to  give  the  patient  cod 
liver  oil,  iron,  or  potassium  iodide  for  long  periods,  to  maintain 
his  health  in  as  good  condition  as  possible,  and  to  send  him  to 
some  hot  springs  or  other  health  resort.  As  the  belief  that  in  it 
we  have  a  distinct  disease  process  exhibiting  a  characteristic 
symptom  complex  has  gained  ground,  however,  investigation 
has  been  directed  more  and  more  toward  ascertaining  what 
therapeutic  measures  are  logically  indicated  by  its  clinical 
phenomena,  and  in  what  degree  such  deductions  as  to  therapy 
are  confirmed  by  the  actual  application  of  these  measures.  As 
a  result,  evidence  is  accumulating  which  indicates  that  modern 
therapy  is  capable  of  producing  curative  results  in  many  cases, 
and  marked  amelioration  of  the  symptomatology  in  a  large 
majority  of  them ;  that  arthritis  deformans  is  about  to  be  res- 
cued from  the  category  of  hopelessly  incurable  diseases. 

We  may  preface  our  consideration  of  the  subject  of  treatment 
by  the  flat  statement  that  any  measure  or  remedy  that  tends, 
inherently  or  indirectly,  toward  repeated  or  sustained  depres- 
sion of  the  vitality  of  the  individual  is  to  be  unqualifiedly  pro- 
hibited. 

Local  Dry  Hot  Air  Application. — As  has  already  been  in- 


Arthritis  Deformans.  189 

timated,  this  measure  does  not  constitute  an  important  element 
in  the  management  of  this  disease.  As  it  is  sometimes  fairly 
efficient  in  relieving  pain,  it  should  always  be  given  a  tentative 
trial  when  this  symptom  is  troublesome.  The  technique  is  that 
usual  to  the  treatment. 

General  Dry  Hot  Air  Application. — The  temperature 
should  usually  not  be  less  than  350°  F ;  as  atheromatous  arteries 
are  commonly  met  with  in  these  patients,  it  may  be  necessary 
to  give  less  heat  during  the  first  two  or  three  treatments  until 
the  arteries  have  softened  some,  but  350°  F.  can  be  attained 
safely  afterward.  The  guide  is  found  in  the  circulatory  phen- 
omena, as  described  in  the  chapter  on  "  Technique." 

Sometimes  the  first  treatment  cannot  last  more  than  fifteen 
minutes,  and  the  requisite  rise  in  temperature  and  pulse  cannot 
be  attained,  but,  as  the  arteries  begin  to  regain  their  elasticity 
the  response  is  more  and  more  kindly,  until  finally  the  proper 
amount  of  influence  upon  the  nerve  centers  can  be  induced. 

The  toes  of  patients  with  this  disease  seem  particularly  liable 
to  suffer  from  the  heat  during  the  treatment,  I  presume  be- 
cause of  inefficiency  in  the  blood  circulation,  and  if  the  appa- 
ratus is  not  so  constructed  as  to  permit  of  the  feet  being  ex- 
cluded from  its  interior,  it  will  frequently  be  found  necessary 
to  bring  into  play  all  the  maneuvers  described  in  the  chapter 
on  "  Technique  "  for  the  relief  of  the  condition. 

Efficient  treatment  of  these  cases  will  frequently  take  an 
hour,  but  the  degree  of  response  which  means  efficiency  must 
be  reached  or  the  patient  will  not  get  his  due  in  the  way  of 
benefit.  The  mere  induction  of  perspiration,  however  profuse, 
as  has  been  stated  on  a  previous  page,  does  not  mean  that  the 
treatment  has  been  properly  completed.  The  requisite  rise  in 
temperature  and  pulse-rate  does. 

In  this  disease,  again,  it  is  particularly  necessary  to  apply 
the  higher  degrees  of  treatment  intensity  and  to  run  the  heat 
up  quickly,  so  as  to  secure  the  necessary  degree  of  physiological 
influence  as  rapidly  as  possible.  By  this  method  we  secure  a 
profound  stimulation  of  physiological  function,  which  is  what 
we  desire  to  effect,  whereas,  if  the  patient  is  treated  for  long 
periods  with  the  lower  degrees  of  heat,  the  ultimate  result  is 


190  Therapeutics  of  Dry  Hot  Air. 

likely  to  be  relaxing,  depressing,  and  pernicious.  The  distinc- 
tions drawn  between  the  effects  of  the  different  methods  of 
applying  heat  and  dry  hot  air  body  treatments  in  the  chapter 
on  "  Physiological  Action  "  apply  with  force  in  connection  with 
this  disease. 

Additional  Remedial  Measures. 

Electricity. 

The  next  most  useful  of  the  physiological  agents  is  electricity, 
and  the  several  forms  of  current  have  distinct  and  different 
spheres  of  influence.  The  one  of  greatest  utility  is  that  derived 
from  the  static  machine,  and  the  wave  current  and  the  spark 
are  the  most  frequently  serviceable  modalities.  Some  authors 
claim  to  have  cured  cases  with  the  static  current  alone,  but  such 
an  instance  has  never  come  within  our  personal  experience,  and 
it  is  usually  difficult  enough  to  benefit  these  patients  materially 
when  all  the  resources  at  our  command  are  brought  into 
action. 

The  Static  Current. — During  the  acute  stage  the  wave 
current  may  be  applied  to  the  affected  joints  twice  daily  by 
means  of  sheet  tin  electrodes  molded  to  the  parts,  and  this 
modality  is  frequently  very  effective  in  relieving  pain.  The  in- 
fluence of  every  static  application  is  general  as  well  as  local, 
no  matter  how  the  treatment  is  localized,  and  the  effect  upon 
the  organism  at  large  is  often  happy  to  a  degree. 

The  brush  discharge  from  the  wooden  or  carbon  electrode 
applied  to  the  affected  part  for  fifteen  or  twenty  minutes,  is 
effective  in  relieving  the  neuralgias  as  well  as  the  aching 
pains  of  the  acute  condition,  in  a  certain  number  of  cases. 

Sparks  may  be  applied  over  the  spine  and  general  muscular 
areas  of  the  body  for  their  tonic  effect  at  any  stage  of  the 
disease,  but,  as  a  rule,  they  had  better  not  be  applied  to  joints 
wherein  acute  symptoms  are  manifest.  When  the  acute  process 
has  subsided,  however,  and  the  local  phenomena  have  become 
confined  to  soreness  and  fibrous  enlargement,  I  know  of  no 
measure  which  will  so  frequently  prove  effective  in  removing 
both  as  judiciously  applied  static  sparks. 


Arthritis  Deformans.  191, 

The  various  neuralgias  which  accompany  the  disease  are 
also  amenable,  as  a  rule,  to  the  static  spark.  , 

The  static  wave  current  localized  over  the  solar  plexus  and 
abdomen  will  sometimes  give  excellent  results  in  the  gastric 
and  intestinal  indigestions  which  are  frequently  quite  trouble- 
some. 

D' Arson valization. — The  general  application  of  the  high 
frequency  current  administered  by  means  of  the  spiral  wire 
cage  of  d'Arsonval,  or  the  auto-condensation  cushion  of  Pif- 
fard,  seems  to  promise  much  because  of  its  strong  tonic  ini 
fluence  upon  the  nervous  system  and  general  metabolism,  but 
enough  has  not  yet  been  done  with  it  in  this  disease  to  render 
possible  the  formation  of  reliable  conclusions.  It  has  seemed 
to  have  exercised  a  beneficial  influence  upon  some  cases  in  the 
treatment  of  which  we  have  used  it,  enough  to  encourage  us 
to  continue  observations  upon  it  in  the  future. 

The  Continuous  Current. — This  modality,  in  the  form  of 
central  galvanization,  positive  polarity  active,  negative  dispers- 
ing electrode  over  the  solar  plexus,  is  very  helpful  in  improv- 
ing the  patient's  general  condition  and  as  a  sedative  to  the 
nervous  system,  but  I  have  never  been  able  to  secure  any  local 
effects  with  it  in  this  disease  upon  the  joint  conditions  that  I 
could  not  have  secured  just  as  well,  and  usually  better,  with 
something  else,  whether  the  current  volume  was  weak  ( 5  ma.') 
or  strong  (75  ma.),  except  in  muscular  spasm  due  to  nerve 
irritation;  in  the  torticollis  of  arthritis  deformans  the  contin- 
uous current,  in  doses  of  from  5  to  20  ma.  for  fifteen  minutes, 
will  sometimes  give  more  satisfaction  than  anything  else  as 
regards  relief  of  both  pain  and  spasm. 

In  applying  central  galvanization,  the  brain  is  treated  first, 
and  it  should  be  remembered  that  great  care  must  be  exercised 
when  using  this  current  upon  this  region  of  the  body.  Be- 
ginning with  the  current  at  zero,  it  should  be  increased  gradu- 
ally, diminishing  the  volume  immediately  if  dizziness,  faintness, 
or  nausea  occurs ;  it  is  very  easy  to  throw  a  patient  into  syncope 
during  this  operation.  Usually  from  3  to  5  milliamperes  for 
three  or  four  minutes  will  be  enough.  In  the  cervical  region  the 
milliamperage  may  be  increased  to  from  5  to  15,  according  to 


192  Therapeutics  of  Dry  Hot  Air. 

the  patient's  tolerance,  for  five  minutes.  The  dorsal  and  lumbar 
regions  may  be  treated  for  five  minutes  each,  and,  as  no  danger- 
ous symptoms  are  to  be  feared  in  these  vicinities,  the  current 
volume  may  be  increased  until  the  cutaneous  sensibilities  revolt, 
which  occurs  ordinarily  at  from  20  to  30  milliamperes. 

It  has  been  stated  that  the  soreness  in  the  joints  may  be  re- 
lieved by  treating  them  with  weak  galvanic  currents,  positive 
polarity,  using  a  hot-water  bath  in  which  the  affected  members 
are  immersed  as  the  active  electrode.  Although  we  have  tried 
this  repeatedly,  we  have  never  been  able  to  convince  ourselves 
that  any  more  benefit  resulted  than  would  be  produced  by  the 
hot  water  alone  without  the  current,  and  in  acute  cases  the 
suffering  has  occasionally  been  increased  apparently.  It  is  un- 
questionably greatly  inferior  to  the  static  modalities,  faradism, 
and  dry  hot  air  in  this  situation. 

Magnetic-Induced  Current. — This  current  plays  very  little 
part  in  the  treatment  of  arthritis  deformans  when  a  static 
machine  is  available,  but  when  it  is  not,  a  good  high  tension 
coil  is  very  useful  as  a  temporary  sedative. 

The  current  is  passed  directly  through  the  aching  joints  with 
a  strength  as  great  as  is  consistent  with  the  patient's  comfort, 
and  the  relative  positions  of  the  polarities  is  usually  a  matter 
of  indifference.  In  the  form  of  spinal  and  general  faradization, 
it  exercises  a  very  helpful  influence  upon  the  deep  nerve  centers 
and  general  metabolism.  In  rare  cases  it  will  be  found  that  the 
coil  gives  sedative  results  in  this  disease  superior  to  those  pro- 
duced by  the  static  modalities  or  dry  hot  air.  It  may  be 
applied  as  often  as  pain  demands  it  without  injury  to  the 
patient. 

Mechanical  Vibratory  Stimulation. — This  remedial  agent 
has  not  yet  been  used  extensively  enough  to  justify  the  forma- 
tion of  an  opinion  as  to  its  curative  powers  in  the  treatment  of 
this  affection.  It  is  undoubtedly,  however,  a  powerful  general 
tonic ;  it  will  relieve  the  pain  of  muscular  spasm  and  relax  the 
spasm  more  effectively  than  any  other  measure  with  which  I 
am  acquainted  except  anaesthesia,  and  it  is  powerfully  and 
harmlessly  sedative  to  the  irritable  nervous  system ;  in  all  of 
these  capacities  it  enters  logically  into  the  management  of  ar- 


Arthritis  Deformans.  193 

thritis  deformans,  and  will  be  found  practically  of  decided  value 
and  assistance. 

Massage. — Massage,  either  general  or  local,  will  very  rarely 
have  to  be  considered  in  the  treatment  of  this  affection  when 
the  agencies  already  mentioned  are  available.  When  they  are 
not,  however,  it  will  be  found  useful  in  relieving  pain,  locally, 
and  in  improving  the  patient's  condition  generally. 

Diet. — The  widespread  impression  that  gout  and  rheumatism 
were  largely  concerned  in  the  etiology  of  the  disease  is  respon- 
sible for  the  common  practice  of  denying  these  patients  red 
meats,  and  sometimes  all  meats.  We  believe  that  this  restric- 
tion is  not  only  unnecessary  usually,  but  that  it  frequently  in- 
flicts positive  harm  upon  the  patient.  Malnutrition  is  an  almost 
constant  characteristic  of  this  disease,  and  the  more  nourishing 
and  generous  the  diet,  within  reasonable  limits,  the  more  will 
the  progress  towards  recovery  be  facilitated. 

These  dietary  limits  are  represented  by  the  capacity  of  the 
individual  patient  for  digesting  and  assimilating  his  food,  and 
must  be  defined,  as  regards  both  quantity  and  variety,  by  this 
capacity  as  ascertained  in  each  individual  case.  It  has  been  our 
experience  that,  as  a  rule,  meats  of  all  kinds  except  pork  are 
well  digested  and  assimilated  by  these  patients,  and  are  bene- 
ficial, and  that  restriction  is  much  more  frequently  required 
with  reference  to  the  starches  and  sugars.  Intestinal  indiges- 
tion demands  attention  in  these  cases  with  a  moderate  degree 
of  frequency. 

Clothing.— In  any  disease  exhibiting  more  or  less  constant 
pain  as  a  symptom,  a  good  quality  of  woolen  underclothing, 
of  light  weight  in  the  summer  and  moderately  heavy  in  the 
winter,  is  a  source  of  comfort  to  the  patient  in  protecting  the 
skin  from  sudden  changes  of  temperature,  which  are  liable  to 
increase  the  pain;  arthritis  deformans  is  no  exception  to  the 
rule. 

Protection  of  the  skin  by  woolen  undergarments  renders 
another  service  by  maintaining  the  function  of  this  emunctory, 
which  is  so  important  a  factor  in  the  general  bodily  metabolism. 
Impairment  of  general  metabolism  is  usually  a  prominent 
feature  of  this  disorder. 


194  Therapeutics  of  Dry  Hot  Air. 

Drugs. 

The  drug  treatment  of  uncomplicated  arthritis  deformans 
confines  itself  within  very  narrow  limits,  and  is  unsatisfactory 
in  the  extreme,  as  far  as  the  obtaining  of  curative  results  is 
concerned.  The  internal  administration  of  medicines  is  indi- 
cated for  two  purposes;  to  favorably  influence  the  course  of 
the  primary  disease  process,  and  to  mitigate  the  symptoms. 

Alteratives  and  Tonics. — Only  a  very  few  elements  of  the 
materia  medica  have  succeeded  in  gaining  a  lasting  reputation 
in  this  connection,  and  all  of  those  that  have,  except  the  salicy- 
lates,  are  of  the  "  Tonic  "  and  "  Alterative  "  classes,  hence 
exert  their  beneficial  influence  through  their  power  to  improve 
the  general  metabolic  functions.  Prominent  among  these  may 
be  mentioned  the  iodide  of  iron,  cod  liver  oil,  the  hypophos- 
phites,  arsenic  in  its  various  combinations,  strychnia,  the  chlo- 
ride of  gold  and  sodium,  and  potassium  iodide. 

The  first  mentioned  has  given  us  the  best  results,  improve- 
ment usually  manifesting  itself,  when  it  obtains  at  all,  in  about 
three  weeks  after  the  commencement  of  its  administration.  It 
should  be  given  for  periods  of  from  three  to  six  weeks,  with 
intermissions  of  two  or  three  weeks. 

Cod  liver  oil  does  good  service  in  those  cases  characterized 
by  emaciation,  if  well  borne  by  the  stomach. 

Arsenic  and  strychnia  are  fairly  useful  in  many  instances  as 
general  tonics. 

The  chloride  of  gold  and  sodium  and  potassium  iodide  or 
hydriodic  acid  sometimes  seem  to  render  considerable  service, 
but  they  fail  to  influence  the  disease  in  such  a  large  proportion 
of  cases  that  their  efficiency  is  not  nearly  as  great  as  is  generally 
supposed. 

Quinine  has  been  lauded  as  a  remedy  for  arthritis  deformans, 
but  we  have  never  been  able  to  convince  ourselves  that  it  was 
of  any  service  in  any  of  the  cases  to  which  we  have  adminis- 
tered it,  and  regard  its  claim  to  efficiency  in  the  management 
of  this  disease,  per  se,  as  open  to  grave  doubt. 

The  Salicylates. — The  relation  of  the  salicylates  to  this 
disease  deserves  a  special  mention,  as  they  sometimes  render 


Arthritis  Deformans.  195 

excellent  service  in  relieving  pain  and  swelling.  Although  it 
is  improbable  that  rheumatism  is  an  etiological  factor  in  any 
considerable  number  of  cases,  yet  it  is  not  so  very  uncommon  to 
see  an  attack  of  rheumatism  engrafted  upon  an  already  existent 
arthritis  deformans,  and,  as  the  salicylates  fail  absolutely  in  so 
many  manifestly  uncomplicated  cases,  it  seems  reasonable  to 
consider  that  many  of  those  in  which  they  are  useful  are  in- 
stances of  such  a  complication.  The  fact  that  beneficial  in- 
fluence is  obtainable  by  their  use  only  up  to  a  certain  point 
would  favor  this  view.  The  difficulty  of  making  a  positive 
diagnosis  of  rheumatic  invasion  under  such  circumstances  is, 
in  many  cases,  of  course,  insuperable.  Whatever  the  explana- 
tion, the  fact  remains  that  the  salicylates,  especially  aspirin,  are 
sometimes  very  helpful  in  relieving  painful  joint  conditions 
occurring  during  the  course  of  arthritis  deformans. 

Laxatives. — Constipation  is  sometimes  present  in  a  degree  to 
demand  attention,  and  the  various  mineral  waters,  sodium  phos- 
phate, magnesium  sulphate,  the  aloin,  strychnia,  and  belladonna 
mixture,  or  compound  licorice  powder,  will  be  found  helpful. 
What  particular  one  should  be  used  must  be  determined  by  the 
tolerance  of  the  individual  patient. 

Digestants. — Digestive  disorders  can  generally  be  controlled 
by  regulating  the  diet,  but  the  digestive  ferments,  carminatives, 
charcoal,  bismuth  subnitrate,  and  strychnia  will  sometimes 
have  to  be  called  upon  to  assist  in  this  work. 

Pain-Relieving  Agents. — The  constant  harassing  pain  is 
one  of  the  most  troublesome  symptoms  of  the  disease  as  far  as 
management  is  concerned.  Most  of  these  patients  have  become 
so  habituated  to  pain  that  they  bear  a  moderate  amount  without 
much  complaint,  but  sometimes  severe  exacerbations,  lasting  for 
several  hours,  days,  or  weeks,  will  occur  which  demand  atten- 
tion. Opium,  or  any  of  its  derivatives,  is  inadvisable  because 
of  the  chronic  character  of  the  trouble,  because  it  loses  its 
influence  in  a  very  few  days  unless  given  in  increasing  doses, 
and  because  of  its  evil  effects  upon  the  system  at  large.  We 
have  occasionally  given  coal  tar  derivatives  when  the  paroxysms 
were  very  severe,  but  they  also  produce  undesirable  effects 
upon  the  metabolic  and  circulatory  functions  when  continu- 


196  Therapeutics  of  Dry  Hot  Air. 

ously  administered  in  effective  doses  for  any  length  of  time. 
None  of  the  ordinary  pain-relieving  drugs  are  of  much  service 
in  controlling  this  symptom,  with  the  exception  of  the  salicy- 
lates,  as  hereinbefore  mentioned. 

Much  relief,  however,  can  usually  be  obtained  by  the  use  of 
external  applications,  and  baume  analgesique  (Bengue),  the 
tincture  of  iodine  externally,  and  the  various  anodyne  lotions 
have  given  us  better  results  than  anything  else.  The  hot  water 
bag,  or  in  some  cases,  the  ice-cap,  is  very  useful  in  this  connec- 
tion, but  when  the  latter  is  used  the  effect  should  be  closely 
watched,  as  it  will  occasionally  precipitate  severe  neuralgias 
if  applied  too  long. 

Management  of  Affected  Joints. 

During  the  acute  stages  the  joints  involved  should  be  kept  at 
rest;  I  do  not  mean  such  complete  rest  as  would  necessitate 
enclosing  the  member  in  a  splint,  but  the  patient  should  be 
directed  not  to  use  the  joint  to  such  a  degree  as  to  produce  pain. 
Patients  are  sometimes  urged  to  force  the  joints  to  functionate 
no  matter  how  exquisite  the  anguish  induced,  and  the  effect 
is  usually  to  increase  the  local  pathology  already  present,  to  say 
nothing  of  the  evil  influence  upon  the  general  nervous  system ; 
nothing  is  more  depressing  than  severe  and  long-continued 
pain.  These  remarks  also  apply  to  passive  movements. 

After  the  acute  process  has  subsided,  judiciously- regulated, 
gradually-increased  movements  of  the  stiffened  joints,  both 
active  and  passive,  are  beneficial,  and  frequently  partial  anchy- 
losis can  be  entirely  removed  thereby,  but  the  sudden  forcible 
breaking  down  of  the  anchylosis  of  arthritis  deformans,  when 
it  exists  to  any  great  degree,  is  a  procedure  which  we  have 
never  seen  followed  by  anything  but  evil  results  in  the  way  of 
increased  and  usually  entirely  hopeless  anchylosis,  and  in  men- 
tioning the  procedure  I  desire  to  express  my  conviction  that  it 
should  be  expunged  from  the  therapeutical  category  of  this 
disease. 

Routine  Treatment. 

Although  dry  hot  air  alone  will  cure  some  cases  of  ar- 
thritis deformans,  yet,  as  I  have  already  said,  it  is  sufficiently 


Arthritis  Deformans.  197 

difficult  to  benefit  the  majority  of  these  patients  materially, 
even  when  we  use  all  the  resources  at  our  command ;  this  im- 
plies the  desirability  of  giving  them  the  benefit  of  everything 
that  is  known  to  exhibit  helpful  properties,  and  brings  up  the 
question,  "What  are  the  most  advantageous  combinations?" 
That  which  has  given  us  the  most  satisfaction  as  a  routine 
treatment,  to  be  modified  according  to  the  conditions  surround- 
ing the  individual  cases,  is  as  follows: 

1.  A  diet  as  generous  as  can  be  digested  and  assimilated  by 
the  individual  case,  and  consisting  largely  of  red  meats. 

2.  Rest  in  bed  for  at  least  twelve  hours  out  of  the  twenty- 
four. 

3.  A  pill  consisting  of  1-40  of  a  grain  of  strychnia  sulphate, 
and  i  1-2  grains  of  ferrous  iodid  three  times  daily  half  an  hour 
before  meals,  and  in  the  emaciated  cases  one  to  four  drams  of 
cod  liver  oil  three  times  daily  after  meals. 

4.  A  dose  of  some  one  of  the  mineral  waters  or  sodium  phos- 
phate before  breakfast,  every  two  or  three  days,  if  constipa- 
tion is  present. 

5.  A  body  dry  hot  air  treatment  two  or  three  times  weekly. 

6.  Central  galvanization  once  or  twice  weekly. 

7.  A  general  application  of  mechanical  vibratory  stimulation 
two  or  three  times  weekly. 

8.  A  static  electrical  application  at   least  once   every   day, 
consisting  in  acute  cases  of  the  Morton  wave  current  localized 
over  the  affected  joints  or  spine,  and  in  the  chronic  cases  of 
long,  thick  sparks  to  the  affected  joints  one  day,  and  the  Morton 
wave  current  localized  over  these  joints  the  next.     In  some 
cases  some  one  of  the  high  frequency  currents  applied  either 
locally  or  generally  may  advantageously  replace  sortie  of  these 
static  applications  or  be  added  to  them. 

9.  With  anchylosed  joints,  wherein  the  acute  condition  has 
subsided  and  the  functional  impairment  is  not  due  to  osteophyte 
formation   (and  in  our  experience  it  has  not  frequently  been 
due  to  this  condition),  passive  movements  every  day,  in  the 
form  of  alternate  forced  flexion  and  extension,  the  attempt 
being  made  to  increase  the  excursion  of  the  manipulated  mem- 
ber each  time,  are  of  considerable  use.    The  movements  should 


198  Therapeutics  of  Dry  Hot  Air. 

not  be  violent  enough  to  produce  sudden  breaking  down  of  the 
offending  tissue,  or  to  cause  the  patient  much  pain,  otherwise 
the  original  pathological  process  is  very  likely  to  be  re-awak- 
ened and  the  last  condition  of  the  victim  will  be  worse  than  the 
first.  The  effects  of  these  movements  should  be  carefully 
watched,  as  this  same  evil  result  will  follow  if  they  are  com- 
menced too  early. 

The  advantages  contingent  upon  temporary  suspension  of 
treatment,  which  were  suggested  in  the  section  upon  "  Inter- 
missions in  Treatment,"  Chapter  III.,  are  sometimes  very 
noticeable  in  arthritis  deformans.  Our  custom  is  to  keep 
the  patient  at  the  sanitarium  for  six  or  eight  weeks,  or  until  he 
has  improved  substantially,  for  the  first  course,  and  then  send 
him  away  for  a  month ;  he  then  returns  to  the  sanitarium  for 
three  or  four  weeks  more,  after  which  he  is  recommended  to  go 
away  again.  The  time  duration  of  the  courses  of  active  treat- 
ment, and  of  the  intervals  between  them,  will,  of  course,  have 
to  be  governed  by  the  conditions  surrounding  the  individual 
cases  as  regards  the  degree  of  improvement  attained,  etc. 

RELAPSES. 

Cases  of  arthritis  deformans  are  very  apt  to  relapse  during 
the  first  year  after  recovery.  A  very  common  cause  is  an 
attack  of  some  acute  disease  of  a  debilitating  nature,  as  la 
grippe ;  another  is  that  patients  who  have  been  accustomed  to 
an  active  life  before  the  disease  disabled  them  are  so  elated  and 
confident  at  being  again  in  condition  to  do  something  after 
months,  and  sometimes  years,  of  enforced  idleness,  that  they 
overwork.  The  overstrained  nerve  centers  yield  as  they  did 
before,  and  another  outbreak  obtains.  In  fact,  anything  tend- 
ing to  lower  the  general  vitality  is  liable  to  result  in  a  reappear- 
ance. It  may  involve  the  same  old  joints,  or  entirely  new  ones 
may  be  invaded,  and  those  affected  previously  escape  alto- 
gether. 

The  victims  should  be  gotten  under  thorough  treatment 
again  as  soon  as  possible,  and  this  should  be  persevered  in  until 
recovery  supervenes.  Under  the  very  best  of  conditions  re- 
covery is  a  matter  of  months,  but  when  we  reflect  that  in  the 


Arthritis  Deformans.  199 

past  we  have  been  able  to  accomplish  scarcely  anything  with 
any  degree  of  certainty  in  any  length  of  time,  the  possession 
of  measures  which  will  restore  to  some  of  these  victims  useful 
joints  and  comfort  in  living  is  a  matter  upon  which  we  may 
most  sincerely  congratulate  ourselves  and  our  patients,  however 
long  it  takes  to  do  it.  Perseverance  is  a  grand  omniscient  word 
in  the  treatment  of  this  affection. 


CHAPTER   X. 

PERITONITIS;  PLEURITIS;  SYNOVITIS;  NEURITIS 
AND  SCIATICA;  LITH^MIA  AND  GOUT;  NEU- 
RALGIA AND  MYALGIA;  VARICOSE  ULCERS; 
OTITIS. 

In  the  preceding  chapters  the  different  phases  of  the  physio- 
logical action  and  clinical  results  of  dry  hot  air  applications 
have  been  discussed  and  illustrated  with  sufficient  thoroughness 
to  render  apparent  what  effects  may  be  expected  to  follow  their 
use  in  most  of  the  pathological  conditions  commonly  encoun- 
tered, and  how  these  effects  are  produced.  In  the  affections 
which  remain  to  be  considered,  therefore,  the  subject  will  need 
to  be  treated  but  briefly. 

PERITONITIS. 

Varieties. — This  disease  is  usually  secondary  to  some  other 
affection,  as  benign  or  malignant  tumors,  salpingitis,  appendi- 
citis, etc.  It  is  also  caused  by  tuberculous  infection  of  the  peri- 
toneum, sometimes  apparently  by  microbic  invasion  from  the 
intestinal  canal,  and  occasionally  an  instance  is  encountered 
during  the  course  of,  and  seemingly  traceable  to  the  specific 
etiological  factor  pertaining  to,  an  infectious  fever. 

Sphere  of  Usefulness  of  Dry  Hot  Air. — When  peritoneal 
inflammation  is  microbic  in  causation  and  confined  to  the 
membrane  itself,  it  will  usually  yield  kindly,  rapidly,  and  per- 
manently to  dry  hot  air;  the  condition,  under  these  circum- 
stances, may  be  likened  to  local  septic  infection,  as  far  as 
thermotherapy  is  concerned.  When  it  is  secondary  to  some 
other  condition,  however,  permanent  cure  will  necessitate  eradi- 
cation of  the  exciting  cause.  When  this  cause  is  a  benign 
neoplasm,  operative  interference  must  be  considered ;  if  the 
growth  is  malignant,  operation  or  X-ray  exposures,  or  both  in 
many  cases ;  if  a  deep,  localized  septic  process,  as  appendicitis 


Per  it  on  it  is.  20 1 

for  instance,  operation  must  always  be  considered  early  and 
earnestly. 

One  of  the  most  prominent  and  harassing  symptoms  accom- 
panying nearly  all  forms  of  peritoneal  inflammation,  except 
that  due  to  the  tubercle  bacillus,  is  pain.  Dry  hot  air  will  al- 
ways relieve  completely  that  proportion  of  it  which  is  caused 
by  the  peritonitis  proper,  and,  as  this  remedy  may  be  applied  as 
often  as  the  pain  recurs,  the  patient's  comfort  may  be  main- 
tained indefinitely. 

In  salpingitis  coming  under  treatment  moderately  early  and 
before  suppuration  has  been  established,  the  knife  will  rarely 
"be  needed  for  obtaining  control  of  the  condition.  The  body 
,  treatment  two  or  three  times  a  week,  in  combination  with  the 
local  once  or  twice  daily,  will  usually  effect  a  rapid  and  com- 
plete subsidence  of  the  pathological  process,  and  the  writer  has 
seen  several  cases  recover  under  the  local  application  alone. 
The  body  treatment,  however,  always  hastens  the  result,  and 
in  some  cases  its  use  is  imperative.  The  deeply-seated  aches 
and  pains  due  to  the  salpingitis  itself  are  controlled  by  the 
body  treatment  more  effectually  than  by  the  local  application 
in  many  cases. 

The  writer  has  never  had  the  courage  to  rely  upon  the  ther- 
mal agent  alone  for  the  cure  of  appendicitis,  but  Burwash  of 
Chicago  reports  two  cases  which  he  carried  to  a  successful  ter- 
mination with  this  measure  only.  It  seems  to  me,  however,  that 
in  view  of  the  ever  present  difficulty,  if  not  impossibility,  of 
differentiating  clinically  those  cases  of  appendicitis  which  are 
due  to  impaction  of  a  foreign  body  from  those  which  are  caused 
purely  by  germ  infection,  we  should  not  feel  justified  in  aban- 
doning early  operation  for  the  treatment  by  dry  hot  air.  If  all 
cases  were  of  the  latter  etiological  type,  thermal  applications 
would  undoubtedly  prove  curative  in  the  vast  majority  of  in- 
stances, but  they  could  not,  and  should  not,  be  relied  upon 
exclusively  in  the  former.  This  agent  is  very  effective  in  limit- 
ing inflammatory  processes,  and,  as  repair  of  wounds  and 
abscess  cavities  is  always  greatly  hastened  by  its  use,  it  may  be 
applied  while  waiting  for  operation  if  pain  is  troublesome  or 
when  the  patient  is  sufficiently  ill-advised  to  refuse  operation. 


COLLlElilE 

t-  u  \  s  i  e  i 


2O2  Therapeutics  of  Dry  Hot  A  ir, 

In  tuberculous  peritonitis,  the  occasional  splendid  results 
which  have  followed  a  simple  laparotomy  give  ground  for  the 
belief  that  this  agent  may  prove  to  be  of  benefit  here.  The 
most  probable  explanation  of  the  way  in  which  laparotomy  has 
accomplished  its'  effects  seems  to  be  that  the  absorptive  power 
of  the  peritoneum,  which  is  enormous  under  normal  conditions, 
is  rescued  from  a  temporary  inhibition,  which  has  resulted  in 
so  impairing  the  physiological  resistance  .of  the  membrane  as 
to  allow  pathogenic  germs  to  gain  a  lodgment  and  prolifer- 
ate, by  the  operation ;  that  the  congestion  due  to  allowing  the 
air  or  irrigating  fluids  to  come  in  contact  with  the  membranes, 
so  influences  their  function  as  to  bring  about  the  encapsula- 
tion and  ultimate  phagocytic  destruction  of  the  invading 
micro-organisms.  Dry  hot  air  possesses  the  power  of  inducing 
physiological  congestion,  hence  restoration  of  impaired  ab- 
sorptive function,  to  a  degree  unapproached  by  that  of  any 
other  measure  now  known,  and  if  this  is  the  true  explanation 
of  the  effect  of  laparotomy,  the  thermal  agent  should  be  valu- 
able in  this  affection. 

The  influence  of  the  body  dry  hot  air  application  in  eliminat- 
ing general  toxaemia  and  stimulating  the  general  physiological 
resistance,  is  as  marked  in  this  disease  as  elsewhere,  is  always  of 
great  assistance  in  securing  a  favorable  termination,  and  in 
many  cases  constitutes  the  measure  most  to  be  relied  upon. 

Illustrative  Case. 

It  was  the  results  following  its  employment  in  a  case  of  acute 
peritonitis  that  first  suggested  to  the  mind  of  the  writer  that 
dry  hot  air  might  be  useful  in  pathological  conditions  other  than 
rheumatic  ailments  and  traumatic  joint  affections.  The  case 
was  reported  in  the  New  York  Medical  Journal  in  1899,  and  is 
such  a  striking  illustration  of  the  splendid  results  sometimes 
obtained  by  the  use  of  thermo-therapy  in  this  disease  that  I 
quote  it  from  that  periodical  as  follows: 

"  Miss  L.  L.,  waitress.  Was  called  to  see  the  patient  at  2 
o'clock  A.  M.,  November  8,  1898,  and  found  her  suffering  with 
severe  colic.  She  had  been  feeling  poorly  and  suffering  from 
slight  cramps  in  the  bowels  for  a  week  past.  Abdomen  was 


j  JJG  0 
'i    ?.  c  j 


Peritonitis.  203 

tense  and  tender,  this  last  being  especially  marked  in  the  left 
iliac  fossa.  Bowels  had  been  constipated  during  the  preceding 
week.  Pulse,  72 ;  temperature  per  mouth,  98.6°  F.  I  made  a 
provisional  diagnosis  of  colic  from  indigestion  and  constipation, 
but  as  patient  was  living  in  illicit  relation  with  a  man  about 
town  and  as  I  had  previously  met  with  some  trying  surprises  in 
the  way  of  abdominal  inflammations  during  my  practice,  I  de- 
cided to  call  again  and  watch  her  progress.  I  administered 
morphine,  a  quarter  of  a  grain,  and  ordered  magnesium  sul- 
phate in  teaspoonful  doses  hourly,  to  be  begun  in  the  morning 
and  taken  until  bowels  moved,  then  discontinued.  Patient  was 
comfortable,  so  far  as  pain  was  concerned,  in  half  an  hour,  and 
I  returned  to  my  couch  and  resumed  my  interrupted  slumbers, 

"  Same  day,  6  P.  M. — Found  patient  suffering  acutely  from 
severe  cutting  pains  all  over  the  abdomen ;  pulse  106,  tempera- 
ture 100.5°  F-  Abdomen  tense,  acutely  sensitive  to  touch,  but 
focus  of  tenderness  still  remained  in  left  iliac  fossa  which 
region  was  entirely  intolerant  of  manipulation.  I  was  unable 
to  find  anything  specific  in  the  neighborhood  of  the  appendix, 
changed  my  diagnosis  to  gonorrheal  salpingitis  and  peritonitis, 
and  was  glad  that  I  had  called  again.  Morphine  had  controlled 
pain  pretty  well  for  four  hours,  after  which  it  returned  and 
continued  with  increasing  intensity  up  to  the  time  of  my  visit. 
Magnesium  sulphate  had  produced  two  small  thin  movements, 
accompanied  by  sharp  pains.  I  made  up  my  mind  that  I  was 
in  for  another  of  the  harassing  experiences  which  go  to  make 
up  the  ordinary  management  of  these  cases,  ordered  that 
flannels  wrung  out  of  hot  water  be  constantly  applied  to  the 
abdomen  as  hot  as  could  be  borne  by  the  patient,  gave  her 
another  hypodermic,  left  her  two  quarter-grain  morphine  pills 
to  be  taken  in  case  the  pain  became  unbearable  before  my  next 
visit,  and  put  her  on  an  exclusive  milk  diet. 

"  November  9,  12  M. — Patient  had  been  suffering  intensely 
since  midnight.  Knees  were  drawn  up,  abdomen  much  dis- 
tended, unable  to  make  the  least  movement  without  provoking 
excruciating  agony,  which  was  also  occasionally  exacerbated  by 
attacks  of  retching  which  accomplished  nothing;  she  was  shiv- 
ering and  her  teeth  were  chattering  from  the  exhaustion  due  to 
long-continued  suffering.  Pulse  104;  respiration  28,  very 
shallow  and  quick;  temperature  101.2°  F.  The  morphine  pills 
that  I  had  left  at  my  previous  visit  had  not  been  used,  as  I  had 
requested  her  not  to  take  them  unless  it  was  absolutely  neces- 
sary. With  the  proverbial  capacity  of  her  sex  for  enduring 
pain,  she  had  not  considered  that  the  point  of  absolute  necessity 
had  yet  been  reached.  I  realized  that  something  must  be  done, 
but  I  hated  to  inaugurate  a  systematic  course  of  morphine  with 


2O4  Therapeutics  of  Dry  Hot  Air. 

its  resultant  evils,  particularly  undesirable  in  a  disease  of 
microbic  origin  where  it  is  of  the  first  importance  to  preserve 
the  metabolic  activities  of  the  body  unimpaired ;  as  the  hot 
applications  were  doing  no  good,  however,  it  seemed  the  only 
measure  capable  of  dealing  with  the  situation. 

"  While  I  was  considering,  the  attendant  came  to  the  bedside 
to  renew  the  hot  application.  The  patient  looked  up  at  her  and 
exclaimed,  '  Oh,  is  it  very  hot  ?  '  Upon  being  assured  that  it 
was,  she  remarked,  '  The  hotter  you  get  it  the  better  it 
feels.' 

"  Like  a  flash  my  dry  hot  air  apparatus  rushed  into  my  mind. 
With  it  I  could  apply  a  heat  of  500°  F.,  whereas  the  flannels 
could  not  be  used  at  more  than  160°  F.  I  asked  her  if  it  was 
true  that  the  greater  the  heat  the  greater  the  comfort  she  ex- 
perienced. She  answered  that  if  the  flannels  were  not  very  hot 
they  gave  her  no  relief  at  all.  A  small  ray  that  was  hardly 
strong  enough  to  be  hope  brightened  the  darkness.  If  160°  F. 
of  heat  gave  her  some  relief  from  pain  twice  or  three  times 
that  might  give  her  a  good  deal,  and  by  frequent  repetitions  I 
might  be  able  to  avoid  the  morphine.  The  prospect  was  worth 
the  experiment.  I  told  her  that  I  would  try  something  else  in 
the  afternoon,  and  did  not  administer  any  morphine. 

"  At  4.30  P.  M.  I  applied  dry  hot  air  locally  over  the  abdomen 
with  doubt,  fear  and  trembling.  My  gratification  can  better  be 
imagined  than  described  when,  at  the  end  of  ten  minutes,  the 
sufferer's  face  relaxed  its  pain-distorted  lineaments.  In  thirty 
minutes  she  looked  up  at  me  with  a  quiet  smile,  saying,  '  Oh, 
how  good  that  feels ! '  and  in  forty-five  minutes,  while  still 
under  treatment,  she  had  fallen  exhaustedly  asleep  for  the  first 
time  in  thirty-six  hours. 

"  At  the  conclusion  of  the  treatment  the  patient  expressed 
herself  as  being  entirely  free  from  pain  while  she  kept  still, 
but  when  she  moved  it  was  still  there,  and  manipulation  was 
as  little  tolerated  as  before.  I  left  the  apparatus  there,  directed 
that  I  be  called  immediately  when  pain  returned,  and  departed 
walking  upon  air  because  of  the  result  achieved.  I  expected, 
of  course,  that  a  repetition  would  soon  be  necessary.  However, 
I  had  been  able  to  give  her  a  relief  so  perfect  that  even  mor- 
phine would  have  been  inadequate  for  its  accomplishment,  and 
by  withholding  the  drug  had  been  able  to  preserve  her  mental 
and  physical  functions  unimpaired.  If  I  could  keep  this  up 
I  would  be  willing  to  treat  her  every  hour,  if  necessary.  The 
hours  wore  on,  and  to  my  growing  astonishment  I  received  no 
summons  until,  by  the  following  morning,  I  began  to  fear  that 
another  physician  had  been  substituted  for  me  without  the  for- 
mality of  my  discharge  having  been  observed.  I  found  it  diffi- 


Peritonitis,  205 

cult  of  belief  that  the  treatment  could  have  produced  results 
so  happy  and  so  long  continued. 

"  loth,  12  M. — Patient  greeted  me  smilingly,  reporting  that 
relief  from  pain  had  continued  complete  until  nine  o'clock  the 
preceding  evening,  when,  for  about  fifteen  minutes,  she  suffered 
from  slight  cramps.  At  midnight  she  had  severe  cramps  for  an 
hour,  but  none  since,  and  to  make  a  long  story  short,  I  will  say 
here  that  those  were  the  last  pains  she  suffered.  The  abdomen 
was  relieved  of  its  distention ;  tenderness  upon  pressure  had 
entirely  disappeared  from  the  right  abdomen,  but  was  con- 
siderably in  evidence  in  the  left,  and  very  much  so  in  the  um- 
bilical region  and  below,  from  manipulation  of  which  area  she 
shrank  in  terror.  Bowels  had  functionated  spontaneously  and 
with  little  pain;  was  taking  milk  freely  and  stomach  was  not 
at  all  irritable.  Pulse  72;  respiration  18;  temperature  98.6°  F, 
Dry  hot  air  was  again  administered. 

"  Same  day,  6  P.  M. — Patient  was  and  had  been  entirely  com- 
fortable. Pulse  83 ;  respiration  18 ;  temperature  99°  F.  Di- 
rected that  I  be  called  again  if  pain  recurred,  and  did  not  see 
her  again  until  the  next  day. 

"  nth,  10  A.  M. — Patient  had  slept  uninterruptedly  all  night 
and  was  feeling  hungry.  No  tenderness  was  present  anywhere 
in  the  abdomen  except  over  a  small  area  immediately  inferior  to 
the  umbilicus.  Pulse  72;  respiration  16;  temperature  98.6°  F. 
Dry  hot  air  administered. 

"  Same  day,  9  P.  M. — Patient  had  been  sleeping  some  during 
the  day,  was  entirely  comfortable  and  complained  of  only  very 
slight  tenderness  on  pressure  in  umbilical  region.  Pulse  66; 
respiration  18;  temperature  98.6°  F. 

"  I2th,  8  P.  M. — Found  patient  sitting  up,  dressed,  sewing. 
No  pain  or  tenderness  upon  pressure  was  anywhere  discover- 
able. Pulse  76;  respiration  18;  temperature  98.6°  F. 

"  1 5th,  8  P.  M. — Patient  called  at  my  office  by  appointment. 
Pulse  78;  respiration  20;  temperature  98.6°  F.  Examination 
revealed  slight  tenderness  upon  deep  pressure  over  left  Fal- 
lopian tube;  nowhere  else.  Once  more  administered  dry  hot 
air  and  requested  that  she  report  in  three  days. 

"  i8th. — Reports  that  she  returned  to  her  work  yesterday 
morning.  Feels  as  well  as  she  ever  did  in  her  life,  and  search- 
ing examination  betrays  absolutely  no  sign  of  her  late  illness. 
She  wrote  me  a  letter  from  another  city  two  months  later, 
stating  that  she  was,  and  had  been,  perfectly  well  since  I  last 
saw  her." 


2o6  Therapeutics  of  Dry  Hot  A  ir. 

Treatment. 

Local  Dry  Hot  Air  Application. — The  patient  should  be 
prepared  as  described  in  the  chapter  upon  "  Technique  "  for 
the  abdominal  application,  the  apparatus  connected  and  the 
heat  turned  on;  in  fifteen  or  twenty  minutes  the  patient  will 
be  free  from  pain.  The  application  should  last  an  hour  when 
it  is  possible  to  maintain  jt  that  long  without  the  induction  of 
undue  fatigue,  and  the  temperature  should  be  raised  to  from 
350°  to  400°  F.  When  the  application  is  finished  the  patient 
is  merely  made  comfortable  again  in  bed,  no  special  after- 
treatment  of  the  abdomen  being  required.  The  treatment  may 
be  repeated  as  often  as  the  pain  returns,  but  should  be  applied 
twice  daily  anyway  for  the  first  four  days,  however  comfort- 
able the  patient  may  be. 

General  Dry  Hot  Air  Application. — The  technique  of  the 
body  treatment  in  this  disease  does  not  differ  from  that  usual 
in  this  procedure.  As  the  body  temperature  is  usually  consid- 
erably above  normal  when  the  patient  enters  the  apparatus,  it 
cannot  always  be  relied  upon  as  a  guide  to  the  duration  of  the 
seance  or  the  intensity  of  the  heat ;  the  pulse  acceleration  and 
the  general  effect  upon  the  nervous  system  must  govern.  As  a 
rule  the  treatment  should  last  about  half  an  hour,  and  the  pulse 
should  be  accelerated  to  125  or  130  beats  per  minute.  It  is 
ordinarily  not  wise  to  push  it  beyond  140  beats  per  minute,  and 
the  phenomena  indicating  over-stimulation  should  not  be 
induced. 

The  frequency  of  administration  is  governed  by  the  response 
on  the  part  of  the  patient.  It  will  usually  be  well  to  apply  the 
measure  every  other  day  during  the  first  week,  after  which  the 
interval  may  be  lengthened. 

Additional  Remedial  Measures. 

Aside  from  the  ordinary  care  of  the  alimentary  canal,  inci- 
dent to  this  affection,  surgical  measures  constitute  the  only 
means  additional  to  thermo-therapy  that  will  have  to  be  con- 
sidered in  the  treatment  of  peritonitis. 

When  the  exciting  cause  is  salpingitis,  long-continued  intra- 


Pleuritis.  2 1 1 

vaginal  applications  of  the  rapidly-interrupted  current  from  the 
long,  fine-wire  faradic  coil  through  the  bipolar  electrode,  will 
sometimes  give  temporary  relief  from  pain,  but  the  writer  has 
not  infrequently  seen  suffering  increased  for  several  hours 
thereby;  its  use  therefore  is  not  to  be  unqualifiedly  recom- 
mended in  all  cases. 

The  internal  administration  of  drugs  for  the  relief  of  pain 
is  almost  never  called  for,  and  drug  stimulation  is  entirely 
superfluous  when  a  body  apparatus  is  at  hand  and  usually  when 
the  local  treatment  is  employed  alone. 

The  advantages  dependent  upon  the  employment  of  this 
agent  in  peritonitis,  viz.,  rapid  relief  of  pain,  restoration  of 
absorptive  function  to  the  membranes,  etc.,  have  been  suffi- 
ciently dwelt  upon  to  warrant  omission  of  further  mention,  and 
anyone  who  has  carried  a  patient  through  an  attack  under 
ordinary  management  will  be  in  a  position  to  readily  appreciate 
the  value  of  the  service  it  renders. 

PLEURITIS. 

Varieties. — Of  the  pleurisies  it  may  be  said,  as  of  perito- 
nitis, that  they  are  usually  secondary  to  some  other  affection, 
as  pneumonia,  pulmonary  tuberculosis,  malignant  disease,  etc., 
and  as  in  peritonitis  also,  it  is  evident  that  the  permanent  cure 
of  secondary  pleurisies  will  necessarily  involve  removal  of  the 
exciting  cause.  There  is  another  class  of  pleural  inflammations, 
however,  which  seem  to  originate  in  the  membranes  themselves 
primarily,  and  which  are  at  times  most  refractory.  They  are 
accompanied  by  effusion  into  the  pleural  cavity  and  may  be 
divided  for  thermo-therapeutical  purposes  into  two  classes,  viz., 
those  in  which  the  effusion  is  serous  or  fibrinous — hydrothorax 
and  "  dry  pleurisy  "  respectively — and  those  in  which  the  exu- 
•date  consists  of  pus. 

Sphere  of  Usefulness  of  Dry  Hot  Air. — The  pleurisies 
accompanying  pneumonia,  as  we  have  seen,  and  pulmonary 
tuberculosis,  as  we  shall  see  later,  yield  rapidly  to  dry  hot  air 
applications,  both  as  regards  their  symptomatology  and  intrinsic 
pathology. 

Enough  cases  of  hydrothorax  and  "  dry  pleurisy  "  have  also 


212  Therapeutics  of  Dry  Hot  A  tr. 

been  treated  to  demonstrate  that  this  agent  is  capable  of  ren- 
dering valuable  assistance  here ;  that  aspiration  will  have  to  be 
done  less  frequently  under  such  management,  and  that  when  it 
is  done  the  return  of  the  pleural  membranes  to  normal  structure 
and  function  will  be  quicker  and  more  frequent  than  it  is  at 
present.  A  very  convincing  case  was  reported  by  Burwash  in 
the  Chicago  Medical  Recorder  for  December,  1901.  The  diag- 
nosis indicated  by  the  physical  signs  was  confirmed  by  with- 
drawing some  of  the  fluid  through  an  exploring  needle,  and  the 
patient  was  ill  but  four  weeks  from  the  inception  of  the  attack 
to  its  termination.  The  effusion  was  extensive  enough  at  one 
time  to  produce  dyspnoea  and  interference  with  the  heart 
action.  The  local  application  only  was  used  and  diuretics  and 
strychnia  were  administered  in  combination  therewith. 

The  treatment  of  pyothorax,  however,  is,  always  has  been, 
and  of  course  always  must  be,  operative  interference  ;  but  many 
cases  refuse  to  recover  even  when  resection  has  been  done,  and 
there  is  reason  to  believe  that  dry  hot  air  is  capable  of  reducing 
the  number  of  these  incurables  and  of  greatly  hastening  recov- 
ery in  all  post-operative  cases.  As  these  patients  are  usually 
debilitated  subjects,  it  is  always  wise  and  sometimes  necessary 
to  invoke  the  influence  of  the  body  treatment  upon  general 
metabolism,  as  well  as  the  direct  effect  of  the  local  application 
upon  the  pleurae. 

Treatment. 

Local  Dry  Hot  Air  Application. — The  local  treatment 
should  be  used  twice  daily  for  an  hour  at  from  350°  to  400°  F., 
until  improvement  is  manifest,  and  once  daily  thereafter,  until 
recovery  is  complete.  The  preparation  of  the  patient  and  the 
technique  are  the  same  as  have  already  been  described  in  the 
section  on  pneumonia. 

General  Dry  Hot  Air  Application. — The  body  treatment 
should  be  applied  two  or  three  times  weekly  according  to  the 
effect  upon  the  patient's  general  condition,  and  the  technique 
is  that  usual  to  this  procedure.  As  the  bodily  temperature  is 
not  ordinarily  much  elevated  in  this  affection  its  fluctuation 
during  the  seance  will  usually  be  of  value  in  determining 


Synovitis.  213 

the   length   of   the   treatment   and   the   intensity   of   the   heat 
required. 

Additional  Remedial  Measures. 

The  other  methods  of  physical  therapeusis  are  rarely  of 
value  in  pleuritis,  and  the  dietary,  drug,  and  surgical  manage- 
ment of  the  disease  do  not  differ  from  those  commonly  inci- 
dent to  the  affection,  except  that  anodynes  and  stimulants  are 
very  rarely  called  for  when  dry  hot  air  is  attainable. 

SYNOVITIS. 

Varieties. — The  vast  majority  of  synovial  inflammations  are 
due  to  one  of  four  etiological  factors,  viz.,  trauma,  rheumatism, 
gonorrhea,  or  tuberculosis.  The  writer's  experience  with  dry 
hot  air  in  this  affection  has  been  confined  principally  to  cases 
owning  the  three  first-mentioned  causes,  and  it  has  been  emi- 
nently satisfactory. 

Sphere  of  Usefulness  of  Dry  Hot  Air. — It  is  hardly  neces- 
sary to  state  that  a  case  of  synovitis  of  any  sort  should  be 
gotten  under  treatment  as  early  as  possible.  If  the  traumatic 
form  is  attacked  by  dry  hot  air  within  three  or  four  days  after 
the  injury  has  been  sustained,  the  pain  will  be  relieved  at  once 
and  the  case  will  ordinarily  reach  a  successful  termination 
within  three  weeks.  I  have  never  seen  one  last  over  six  weeks 
even  when  ten  days  had  elapsed  since  the  injury,  and  Corwin 
has  reported  one  case  of  acute  synovitis  of  the  knee  in  a  boy 
fifteen  years  old,  exciting  cause  not  stated,  which  recovered 
completely  with  but  two  treatments.  It  is  the  writer's  belief, 
however,  that  such  a  rapid  response  is  very  rare,  and  he  has 
personally  never  seen  a  case  of  true  synovitis,  whatever  the 
etiology,  recover  in  such  a  short  time,  however  early  it  came 
under  treatment. 

In  the  rheumatic  variety,  on  the  other  hand,  rapid  response 
is  the  rule  when  appropriate  medication  accompanies  the  dry 
hot  air;  the  pain  is  relieved  at  once,  and  recoveries  with  but 
four  or  five  applications  are  not  at  all  uncommon. 

In  gonorrheal  synovitis  it  is,  of  course,  essential  that  treat- 
ment be  directed  against  the  primary  focus  of  infection  as  well 


214  Therapeutics  of  Dry  Hot  Air. 

as  the  joint  mischief,  but  the  use  of  dry  hot  air  on  the  joint 
affected  will  greatly  hasten  the  recovery  and  anchylosis  will 
usually  be  avoided  thereby.  This  is  one  of  the  situations 
wherein  the  agent  cannot  invariably  be  relied  upon  to  effect 
immediate  relief. of  pain;  it  sometimes  makes  it  worse  for 
several  hours  afterward.  The  ultimate  result  attainable  justi- 
fies its  application  even  under  these  circumstances,  however, 
unless  the  pain  is  exacerbated  to  an  unendurable  degree. 

Tuberculous  synovitis  is  the  most  resistant  of  the  varieties 
to  this  as  to  all  other  methods  of  therapeusis.  A  cure  requires 
from  two  to  six  months,  but  in  the  majority  of  the  cases  so  far 
reported  the  joints  have  eventually  been  restored  to  useful 
function,  and  that  without  operative  interference.  If  surgery 
has  finally  to  be  called  upon  the  prospect  of  ultimate  cure  is 
greatly  increased  if  dry  hot  air  has  been  applied,  because  of 
the  improvement  in  the  local  nutrition  effected  by  this  measure. 

Walton  has  reported  most  excellent  results  in  tuberculous 
synovitis,  and  although  our  experience  has  been  slight,  yet  it 
has  encouraged  us  to  undertake  further  investigation.  One 
case  in  particular  responded  most  happily.  The  patient,  a  boy 
seventeen  years  old,  had  been  afflicted  with  tuberculous  disease 
of  the  knee-joint  for  several  years  and  for  the  preceding  four 
years  had  been  under  the  most  approved  treatment.  He  came 
to  the  sanitarium  with  the  leg  in  a  splint  and  the  joint  anchy- 
losed.  A  course  of  local  and  general  dry  hot  air  applications, 
extending  over  a  period  of  five  months,  restored  seventy-five 
per  cent,  of  the  normal  motion  to  the  joint,  enabled  him  to  dis- 
pense entirely  with  the  splint,  stopped  his  daily  temperature 
elevations  and  night-sweats,  increased  his  body  weight,  and, 
in  short,  brought  about  a  condition  of  normal  health.  Near 
the  close  of  the  course  of  treatments  this  patient  was  exhibited 
by  the  writer  before  the  Clinical  Society  of  the  New  York 
School  of  Physical  Therapeutics. 

It  is  probable  that  dry  hot  air  produces  its  beneficial  results 
in  joint  tuberculosis  by  improving  the  nutrition  and  increasing 
the  cell  vitality  of  the  part,  rather  than  by  a  directly  fatal  influ- 
ence upon  the  bacillus  itself,  as  has  been  suggested.  If  the 
germ  were  directly  destroyed  by  the  heat,  the  recovery  would 


Synovitis.  215 

be  immediate,  whereas  it  is  in  fact  always  found  to  be  more  or 
less  slow. 

It  has  been  said  that  dry  hot  air  is  contra-indicated  in  joint 
tuberculosis,  but  as  this  statement  is  not  warranted  by  the 
pathology  of  the  condition,  the  physiological  action  of  the 
agent,  or  actual  clinical  experience,  it  may  be  dismissed  from 
further  consideration. 

Treatment. 

The  knee  is  the  joint  most  frequently  affected  in  synovitis 
and  the  local  treatment  the  one  most  frequently  indicated. 

Local  Dry  Hot  Air  Application. — The  apparatus  designed 
especially  for  this  joint  would  seem  to  be  the  one  most  likely 
to  be  useful  in  this  situation,  but  for  the  reasons  stated  in 
Chapter  III.  the  general  local  apparatus  will  give  better  results 
when  the  joint  is  susceptible  of  sufficient  extension  to  permit 
of  its  use.  The  technique  appropriate  to  the  special  knee 
apparatus  is  fully  described  in  Chapter  III.,  in  the  section  that 
treats  of  this  machine. 

When  the  general  local  apparatus  is  used  the  wrapping 
should  be  started  at  the  toes,  and  the  whole  of  the  limb,  from 
the  toes  to  a  point  a  little  above  the  middle  of  the  thigh,  invested 
in  three  thicknesses  of  the  toweling.  The  limb  is  then  placed 
in  the  apparatus,  the  limiting  attachment  fastened  around  the 
middle  of  the  thigh,  and  the  heat  run  up  to  about  400°  F. 
Whichever  apparatus  is  used,  the  treatment  is  continued  for  an 
hour  and  administered  twice  daily,  or  oftener  if  the  pain  be- 
comes troublesome. 

After-Care. — In  the  traumatic  variety,  after  the  application 
has  been  completed,  it  is  wise  to  wrap  an  elastic  bandage  about 
the  joint  just  tightly  enough  to  produce  a  slight,  even  pressure, 
and  this  should  remain  in  place  until  the  next  treatment. 

In  rheumatic  synovitis  no  compression  or  immobilization 
device  is  called  for.  It  is  desirable  only  that  the  patient  refrain 
from  moving  the  part,  and  this  he  will  ordinarily  do  of  his 
own  volition. 

When  the  exciting  cause  is  gonorrheal  infection,  the  persist- 
ent pressure  of  an  elastic  bandage  can  rarely  be  borne,  but  it 


216  Therapeutics  of  Dry  Hot  Air. 

is  advisable  to  secure  immobility  of  the  joint  by  applying  a 
splint  or  some  retaining  apparatus  until  the  acute  inflammatory 
process  has  subsided.  Passive  motion  may  then  be  employed 
immediately  after  each  treatment. 

Whether  or  -riot  immobilization  shall  be  applied  in  tuber- 
culous synovitis  must  be  determined,  of  course,  by  the  condi- 
tions obtaining  in  the  individual  case. 

General  Dry  Hot  Air  Application. — The  body  treatment  is 
always  extremely  helpful  in  synovitis  of  any  sort,  but  it  is 
rarely  imperatively  indicated  in  cases  due  to  trauma  or  rheuma- 
tism ;  in  gonorrheal  cases,  however,  recovery  is  always  mark- 
edly hastened  by  its  employment,  and  frequently  a  satisfactory 
result  cannot  be  attained  without  it.  We  have  here  a  condition 
comparable  in  many  respects  with  that  obtaining  in  local  septic 
infection,  and  the  technique  of  the  application  here  is  the  same 
as  that  described  for  septic  infection. 

Much  the  same  may  also  be  said  of  tuberculous  synovitis, 
in  which  disease  the  writer  is  of  the  opinion  that  the  body  treat- 
ment should  always  be  employed.  We  have  here,  not  only  a 
localized  process,  but  an  impairment  of  the  vital  functions  gen- 
erally and,  as  we  have  seen,  no  measure  is  more  effectual  in 
combating  a  general  debility  than  the  judiciously-administered 
general  dry  hot  air  application. 

Additional  Remedial  Measures. 

Electricity,  in  the  form  of  the  Morton  static  wave  current, 
the  static  spark,  or  galvanism,  is  very  useful  in  traumatic  and 
rheumatic  synovitis,  the  efficiency  of  the  modalities  being  in  the 
order  in  which  they  are  named.  The  high  frequency  current 
has  been  used  considerably  abroad  in  all  varieties  of  synovitis 
and  good  results  reported,  but  dry  hot  air,  alone,  or  in  combina- 
tion with  one  or  more  of  the  above-mentioned  agents,  will  ordi- 
narily give  results  which  leave  little  to  be  desired  when  the 
lesion  is  due  to  trauma  or  rheumatism. 

The  Morton  wave  current  or  the  brush  discharge  will  some- 
times give  good  results  in  relieving  the  pain  of  the  gonorrheal 
variety,  but  operative  interference  constitutes  the  most  impor- 
tant curative  adjunct  to  be  considered  in  this  condition. 


Neuritis.  217 

In  tuberculous  joint  inflammation  the  latest  therapeutical 
development  is  the  X-ray,  and  this  agent  has  produced  most 
excellent  curative  results  in  some  cases  of  this  affection.  It 
may  be  administered  in  conjunction  with  dry  hot  air  without 
necessitating  any  modification  of  the  usual  technique  pertaining 
to  either  agent. 

The  dietary  and  general  management  of  a  case  of  synovitis 
that  is  being  treated  by  thermo-therapy  does  not  differ  from 
that  ordinarily  indicated,  except  in  the  greatly-lessened  fre- 
quency with  which  pain-relieving  drugs  are  required. 

NEURITIS. 

Etiology. — This  affection  is  another  of  those  owning  a 
varied  causation.  Prominent  among  its  causes  are  excessive 
use  of  certain  sets  of  muscles  and  nerves,  which  is  exemplified 
by  the  brachial  neuritis  sometimes  encountered  among  pen- 
men; the  presence  of  abnormal  substances  in  the  blood,  illus- 
trated by  the  neuritis  of  alcoholism,  plumbism,  and  the  infec- 
tious fevers ;  and  traumatism.  Lithaemia  and  other  constitu- 
tional aberrations  are  also  met  with  among  its  causative  phe- 
nomena, and  there  can  be  no  doubt  that  sudden  chilling  of  the 
body  under  certain  conditions  will  inaugurate  an  attack,  al- 
though the  manner  in  which  it  does  so  is  not  entirely  clear. 
A  neuralgia  so  induced  would  not  be  difficult  to  understand, 
but  in  the  case  of  a  true  neuritis  it  would  seem  as  if  something 
else  must  also  be  etiologically  involved,  and  it  is  probably 
through  an  inhibitory  influence  of  cold  upon  general  metabo- 
lism, whereby  abnormal  and  irritating  products  are  developed 
in  the  circulation,  that  the  attack  is  provoked. 

Treatment. 

It  will  readily  be  appreciated  that  removal  of  the  exciting 
cause  is  a  necessary  factor  in  the  attainment  of  a  cure. 

Dry  Hot  Air. — The  use  of  this  agent  in  neuritis  is,  on  the 
whole,  somewhat  disappointing.  The  local  application  will 
nearly  always  relieve  the  pain  for  a  time,  but  it  almost  invari- 
ably returns  after  a  little  as  badly  as  ever,  and  I  have  never 
been  able  to  convince  myself  that  it  possessed  much,  if  any, 


2 1 8  Therapeutics  of  Dry  Hot  A  ir. 

value  as  a  curative  agent.  The  body  treatment  is  more  useful, 
however,  and  especially  in  those  cases  dependent  upon  consti- 
tutional causes  it  is  fairly  efficient.  Even  at  the  best,  however, 
dry  hot  air  alone  is  not  a  very  reliable  measure. 

Additional  Remedial  Measures. 

Electricity. — The  best  results  are  obtainable  with  the  elec- 
trical currents  in  combination  with  thermal  applications,  and 
my  routine  treatment  is  to  apply  the  body  treatment  two  or 
three  times  weekly  and  some  electrical  modality  twice  daily, 
except  on  the  dry  hot  air  days,  when  one  electrical  treatment  is 
omitted.  The  local  application  of  heat  is  used  ad  libitum  when 
the  pain  is  troublesome,  in  those  cases  wherein  experience  dem- 
onstrates its  value. 

The  electrical  modalities  used  are  the  static  wave  current, 
the  brush  discharge  and  spray  in  recent  cases,  and  sparks  and 
weak  galvanic  currents  in  chronic  cases.  Some  authorities  do 
not  countenance  the  use  of  galvanism  in  neuritis,  and  in  many 
cases  it  will  unquestionably  make  the  trouble  worse.  In  other 
patients,  however,  currents  of  from  three  to  ten  milliamperes 
will  just  as  unquestionably  produce  beneficial  results,  and  if  a 
case  is  not  doing  well  under  other  measures  I  believe  that  it 
should  be  cautiously  tried. 

The  rapidly-interrupted  current  from  the  long,  fine-wire  coil 
is  excellent  for  sedation,  but  I  have  never  observed  that  it 
exercised  much,  if  any,  curative  influence  in  true  cases  of  this 
disease. 

Diet. — The  regulation  of  the  ingesta  will  depend  upon  the 
conditions  obtaining  in  the  individual  case  as  regards  idiosyn- 
crasy, and  whether  or  not  constitutional  and  diathetic  factors 
are  involved  in  the  etiology. 

Drugs. — Medicines  are  not  efficient  against  a  neuritis, /><?r  se, 
but  they  are  useful  for  removing  some  of  the  constitutional 
conditions  upon  which  it  frequently  depends,  as  lithsemia, 
plumbism,  etc.,  and  for  relieving  pain.  They  will  rarely  be 
required  for  the  latter  purpose  when  dry  hot  air  and  electricity 
are  available,  but  when  they  are  required  the  coal  tar  deriva- 
tives will  usually  give  good  satisfaction.  As  the  affection  very 


Sciatica.  219 

frequently  becomes  chronic,  the  administration  of  morphine 
should  be  reserved  for  a  last  resort  and  given  most  guardedly 
then.  Its  after-effects  are  frequently  most  vicious  as  far  as  the 
neuritis  itself  is  concerned,  to  say  nothing  of  the  very  present 
danger  of  making  an  habitue  of  the  patient. 

Physiological  Rest. — Suspension  of  function  of  affected 
parts  is  always  helpful  and  sometimes  imperative  for  restoring 
the  nerve  to  its  normal  condition. 

Sciatica. 

Causation  and  Pathology. — Pain  in  the  sciatic  nerve  and 
its  distribution  exhibits  sufficiently  characteristic  clinical  fea- 
tures to  entitle  it  to  special  mention,  and  as  it  is  more  often 
a  neuritis  than  anything  else  it  will  not  be  out  of  place  to  con- 
sider it  here.  It  is  caused  by  a  variety  of  factors,  prominent 
among  which  may  be  mentioned  tumors  in  the  pelvic  cavity  or 
spinal  canal  so  located  as  to  press  upon  the  structures  that  go 
to  make  up  the  sciatic  nerve ;  pathological  conditions  of  the 
lower  lumbar  or  sacral  vertebrae ;  disease  processes  affecting 
the  hip  joint ;  inflammatory  processes  in  the  nerve  itself,  its 
sheath,  or  those  divisions  of  the  spinal  nerves  which  combine 
to  form  it  (sciatic  neuritis),  set  up  by  traumatism  or  the  various 
general  systemic  toxaemias ;  adhesions  between  the  nerve  and 
its  sheath  resulting  from  antecedent  inflammation ;  excessive 
irritability  of  the  nerve  centers  in  the  lumbar  cord,  such  as  is 
sometimes  met  with  in  general  or  sexual  neurasthenia ;  and 
possibly  rheumatic  infection. 

It  has  been  questioned  upon  entirely  logical  grounds  whether 
a  true  sciatic  ''  rheumatism  "  is  ever  encountered,  but  in  many 
cases  the  clinical  evidence  points  to  the  presence  of  this  infec- 
tion so  emphatically  that  it  does  not  seem  justifiable  to  exclude 
it  from  the  etiological  category  without  more  positive  proof  of 
its  non-existence  than  has  transpired  up  to  the  present  time. 

Sphere  of  Usefulness  of  Dry  Hot  Air. — A  correct  compre- 
hension of  the  etiological  factors  present  in  a  given  case  is  most 
helpful  from  a  therapeutical  standpoint,  and  a  little  vigilant 
investigation  will  usually  suffice  for  its  acquisition.  The  cause 
of  a  sciatica,  rather  than  the  sciatica  itself,  should  constitute  the 


22O  Therapeutics  of  Dry  Hot  Air. 

main  point  of  attack.  If  it  is  an  intra-pelvic  tumor  the  sciatica 
will,  of  course,  not  be  susceptible  of  anything  but  temporary 
removal  until  the  exciting  condition  has  been  disposed  of,  and 
in  the  management  of  this  variety  of  sciaticas,  dry  hot  air  has 
very  little  part.  In  the  management  of  the  others,  however, 
it  plays  a  role  of  varying  but  always  considerable  importance, 
and  its  effects  are  both  indirect  and  direct. 

Its  indirect  effects  are  manifested  in  the  sciaticas  which  are 
caused  by  such  diseases  as  arthritis  deformans,  general  sys- 
temic toxaemias,  etc.,  which  are  susceptible  of  being  influenced 
happily  by  the  body  dry  hot  air  application,  the  sciaticas  dis- 
appearing as  the  primary  condition  improves. 

Its  direct  effects  are  manifested  in  those  sciaticas  which  are 
generally  looked  upon  as  rheumatic,  those  of  traumatic  etiology, 
etc.,  where  the  pathological  processes  are  confined  to  the  nerve 
itself  or  its  immediate  vicinity,  and  are  susceptible  of  being 
influenced  by  the  local  application. 

Its  use  in  the  first-mentioned  class  of  sciaticas  will  be  there- 
fore its  use  in  the  disease  causing  them,  for  the  description  of 
which  the  reader  is  referred  to  the  sections  treating  of  those 
diseases ;  its  employment  in  the  last-mentioned  variety,  or  those 
conditions  in  which  its  direct  effect  is  useful,  is  all  that  will  be 
mentioned  here. 

Illustrative  Case. 

The  case  following  is  one  of  the  so-called  sciatic  "  rheuma- 
tisms "  and  shows  of  what  dry  hot  air  is  capable  when  used  in 
connection  with  appropriate  internal  medication. 

Mr.  M.  T.  M.,  seventy  years  of  age,  consulted  me  September 
24,  1898..  He  had  suffered  constantly  with  sciatic  rheumatism 
for  the  preceding  four  years.  The  exacerbation  of  the  pain 
produced  by  bending  the  hip  joint  was  such  that  he  was 
obliged  to  ascend  a  flight  of  stairs  one  step  at  a  time,  and  the 
pain  was  in  evidence  most  of  the  time  when  at  rest.  He 
had  tried  various  methods  of  treatment,  under  both  profes- 
sional and  lay  guidance,  with  no  satisfactory  results. 

I  treated  him  with  the  usual  drugs,  including  salophen,  for  a 
few  weeks  with  very  slight  benefit,  and  then  administered  local 
dry  hot  air  applications  in  conjunction  with  gram  doses  of 


Sciatica.  22 1 

salophen  three  times  daily.  Ten  minutes  after  the  first  treat- 
ment was  commenced  the  constant  throbbing  pain  ceased.  At 
the  conclusion  of  the  seance  he  was  able,  for  the  first  time  in 
many  months,  to  place  the  foot  belonging  to  the  infirm  leg  upon 
the  opposite  knee  to  lace  his  shoe,  and  to  walk  downstairs  with- 
out pain  or  stiffness. 

Two  days  later  he  returned  for  another  dry  hot  air  treatment, 
reporting  that  he  had  felt  a  few  slight  painful  twinges  that 
morning,  but  nothing  else  since  the  first  application,  except 
when  ascending  a  flight  of  stairs. 

Two  days  after  he  called  again  by  appointment,  reporting 
that  he  had  had  no  pain  at  all  since  the  preceding  application, 
and  that  friends  whom  he  met  on  the  street  were  remarking 
that  he  "  didn't  walk  lame  any  more."  Pain  was  provoked  by 
extreme  flexion  of  the  thigh  upon  the  body,  but  by  no  other 
manipulation.  A  local  dry  hot  air  application  was  administered 
and  the  patient  directed  to  return  in  a  week  anyway,  and  sooner 
if  symptoms  returned. 

At  the  end  of  a  week  he  returned  and  reported  having  had  no 
pain  or  stiffness  of  any  sort  or  degree  since  the  preceding  treat- 
ment. Leg  was  movable  in  any  direction  and  to  any  normal 
extent,  and  no  pain  was  provoked  by  manipulation  of  any  sort. 
Had  been  accidentally  wet  through  twice  since  his  last  visit 
and  been  unable  to  change  his  clothing  for  some  hour§  after- 
wards, but  this  event,  which  would  have  formerly  been  the 
cause  of  severe  symptoms,  had  been  followed  by  no  unpleasant 
sequelae.  Dry  hot  air  was  once  more  administered  and  patient 
discharged,  with  instructions  to  call  again  immediately  if  any 
more  trouble  appeared,  which  he  promised  to  do.  Ten  months 
afterwards  he  was  still  well,  but  I  then  lost  track  of  the  case 
and  do  not  know  his  present  condition.  It  is  reasonable  to  sup- 
pose, however,  that  he  would  have  called  again  had  his  trouble 
recurred. 

Treatment. 

Sciatic  Rheumatism. — The  treatment  of  the  early  stages  of 
what  we  will  take  the  liberty  of  still  terming  "  rheumatic " 
sciatica  should  be  the  same  as  that  of  rheumatic  inflammation 
anywhere,  viz.,  rest,  local  dry  hot  air  applications  to  the  affected 
hip  as  often  as  the  pain  returns  severely  and  once  daily  there- 
after until  the  attack  has  ended,  and  some  salicyl  compound, 
and  it  has  seemed  to  me  that  salophen  usually  gave  better 
results  in  this  situation  than  any  of  the  others.  The  body  dry 
hot  air  treatment  every  two  or  three  days  is  always  very  helpful 


222  Therapeutics  of  Dry  Hot  Air. 

in  this  condition  through  its  influence  upon  general  metabolism, 
but  the  vast  majority  of  cases  get  well  without  it. 

Sciatic  Neuritis. — The  management  of  true  sciatic  neuritis 
not  dependent  upon  gross  surgical  lesions,  is  practically  the 
same  as  when  neuritis  occurs  anywhere  else,  except  that  drugs 
are  useful  only  as  pain-relieving  agents  as  far  as  the  lesion 
itself  is  concerned ;  rest  of  the  affected  leg  is  rather  more  fre- 
quently called  for,  and  the  general  dry  hot  air  application  two 
or  three  times  weekly  constitutes  an  important  element,  as  do 
also  the  other  forms  of  physical  therapeutics.  In  many  cases 
the  disease  will  not  yield  until  the  last-mentioned  agents  have 
been  added  to  the  regimen. 

Electricity. — For  recent  cases  the  static  brush  discharge  for 
twenty  or  thirty  minutes,  or  the  wave  current  localized  over 
the  nerve  back  of  the  trochanter  for  the  same  length  of  time, 
once  or  twice  daily  until  the  acute  stage  has  subsided,  does 
good  service. 

For  the  chronic  cases,  long,  thick  sparks  over  the  course  of 
the  nerve,  or  counter-irritation  with  the  massage  roller  or  brass 
ball  electrode,  may  be  alternated  with  the  wave  current  every 
day  or  two.  Sparks  must  be  applied  cautiously,  as  they  will 
aggravate  the  trouble  if  used  too  soon,  and  some  cases  will  be 
aggravated  by  them  at  any  stage.  In  chronic  sciatica,  however, 
judiciously  chosen  and  applied  static  modalities  are  of  more 
value  than  any  other  measures  with  which  I  am  acquainted, 
excepting  dry  hot  air  and  vibratory  stimulation.  The  imme- 
diate relief  of  pain  which  usually  follows  static  and  thermal 
applications  in  these  cases  is  one  of  the  happiest  of  therapeuti- 
cal experiences.  The  tonic  action  of  Franklinism  upon  the 
system  at  large  is  strongly  in  evidence  under  these  con- 
ditions. 

Opinions  vary  as  to  the  advisability  of  using  the  continuous 
current,  in  acute  sciatica,  and,  as  a  matter  of  fact,  when  dry  hot 
air,  mechanical  vibratory  stimulation,  or  static,  are  available  it 
will  seldom  have  to  be  considered  at  all.  The  usual  immediate 
relief  of  pain  due  to  its  application  is  unquestionable,  but  this 
is  frequently  followed,  after  some  hours,  by  an  aggravation  of 
the  same.  In  cases  where  these  agents  cannot  be  used,  how- 


Sciatica.  223 

ever,  and  even  in  some  cases  where  they  can,  the  continuous 
current  is  useful,  and  may  be  administered  as  follows : 

The  positive  pole  should  usually  be  applied,  stabile,  over  the 
point  of  exit  of  the  nerve  from  the  pelvis  if  the  lesion  is  outside 
of  this  structure,  and  over  the  lumbar  and  upper  sacral  regions 
if  the  lesion  is  within  it,  and  the  negative,  labile,  over  the  course 
of  the  nerve  as  far  down  as  the  pain  extends.  This  usually 
means  clear  to  the  toes,  and  the  current  strength  should  be 
from  five  to  fifteen  milliamperes,  according  to  the  patient's 
tolerance,  for  from  ten  to  fifteen  minutes.  Stronger  currents 
are  likely  to  produce  irritation  enough  to  aggravate  the  symp- 
toms. Very  rarely,  in  acute  cases,  but  more  frequently  in 
chronic,  the  reversed  polarities  give  better  results,  both  as  to 
sedation  and  permanent  benefit.  It  can  be  ascertained  which 
only  by  trial. 

The  rapidly-interrupted,  magnetic-induced  current  from  the 
long,  fine-wire  coil  acts  powerfully  as  a  sedative  in  this  condi- 
tion, but  rarely  accomplishes  much  else. 

It  should  be  remembered  that  in  some  cases  of  this  disease 
any  application  of  any  electrical  current  will  make  the  sub- 
jective condition  worse  at  any  stage  of  the  trouble,  with  the 
exception  of  the  static  wave,  which  I  have  never  known  to 
cause,  or  heard  of  causing,  anything  but  benefit.  It  is  need- 
less to  say  that  when  such  a  case  is  encountered,  electricity 
should  be  kept  religiously  away  from  it. 

Mechanical  Vibratory  Stimulation. — One  of  the  most  use- 
ful of  all  of  the  elements  of  physical  therapy  in  the  treatment 
of  sciatica,  is  mechanical  vibratory  stimulation.  It  is  one  of 
the  newer  therapeutical  measures,  hence  its  actual  position  as 
regards  value  is  yet  to  be  determined,  but  the  enthusiasm  with 
which  its  advocates  commend  its  virtues  indicates  that  it 
possesses  enough  remedial  power  to  insure  it  a  place  of  high 
rank  in  the  therapeutics  of  the  near  future.  The  writer  has 
accomplished  with  it  some  results  in  sciatica  that  he  is  satisfied 
could  not  have  been  attained  by  any  other  means,  and  believes 
that  its  scientific,  rational  employment  will  very  greatly  increase 
our  power  to  overcome  this  sometimes  most  obstinate  affection. 
For  information  regarding  the  theory  and  practice  of  its  em- 


224  Therapeutics  of  Dry  Hot  Air. 

ployment  the  reader  is  referred  to  "  Vibratory  Stimulation,"  by 
the  late  Professor  M.  F.  Pilgrim,  and  published  by  the  Law- 
rence Press  of  New  York  City,  the  first  publication  upon  the 
subject  and  a  thoroughly  reliable  treatise. 

In  what  is  looked  upon  as  true  rheumatic  sciatica,  very  little 
use  will  be  found  for  vibratory  stimulation,  but  in  the  other 
varieties  the  writer  is  prepared  to  maintain  that  it  constitutes 
a  most  valuable  adjunct. 

Immobilization.— Confining  the  patient  to  his  bed  and  splint- 
ing the  affected  leg  for  several  weeks,  thereby  suspending  its 
function,  is  a  measure  that  has  sometimes  been  recommended, 
and  which  may  be  tried  in  cases  that  resist  the  measures  out- 
lined above.  The  writer  has  never  used  this  plan  and  is  not, 
therefore,  competent  to  discuss  it. 

Operative  Interference. — The  assistance  of  surgery  will 
have  to  be  invoked  in  many  cases  of  sciatica  which  are  due  to 
the  presence  of  intrapelvic  or  intraspinal  neoplasms,  but  nerve 
stretching  or  other  operative  measures  involving  the  sciatic 
nerve  structure  itself  are  rarely,  if  ever,  called  for  in  primary, 
uncomplicated  cases  of  this  disease,  when  the  above  remedial 
measures  are  available. 

LITH^EMIA. 

Definition  of  Term. — This  term  is  sometimes  used  as  a 
synonym  of  gouty  diathesis,  but  the  two  conditions  are  not 
identical.  The  latter  term  should  be  restricted  to  the  condition 
occurring  in  persons  who  inherit  the  tendency  to  impaired 
trophic  nerve  function,  which  results  in  suboxidation  of  meta- 
bolic products  and  which  usually  goes  on  to  eventuate  in 
paroxysms  of  true  articular  gout ;  while  the  former  should  be 
used  to  indicate  a  condition  in  which  the  presence  of  suboxi- 
dation products  in  the  system  is  the  result  of  errors  in  living  in 
one  whose  heredity  is  untainted,  and  in  whom  the  condition 
has  not  existed  long  enough  to  induce  the  characteristic  con- 
stitutional phenomena  of  true  gout. 

Etiology,  Pathology,  and  Clinical  Characteristics. — Al- 
though the  symptomatology  of  these  two  classes  is  nearly,  if 
not  quite,  identical  in  their  early  stages,  yet  the  prognosis  and 


Lithcemia.  225 

response  to  treatment  are  very  different.  In  lithaemia  the 
natural  tendency  is  toward  recovery,  and  if  the  exciting  causes, 
viz.,  excesses  and  faulty  habits  of  life,  are  corrected,  the  con- 
dition will  disappear.  If,  on  the  other  hand,  the  patient  per- 
sists in  his  errors,  the  condition  may  go  on  to  the  production  of 
true  gout,  or  one  of  those  diseases  so  closely  allied  to  it — dia- 
betes mellitus  or  obesity;  or  he  may  become  a  neurasthenic 
wreck.  A  surprisingly  large  proportion  of  the  neurasthenic 
cases  encountered  are  traceable  to  impaired  function  of  the 
trophic  nerve  centers  dependent  upon  a  systemic  toxaemia 
induced  by  intestinal  indigestion,  or  inability  to  do  the  work 
forced  upon  them  of  some  other  of  the  viscera  concerned  in  the 
nutrient  function — in  short,  the  presence  in  the  body  of  an 
intolerable  amount  of  the  products  of  suboxidation. 

In  the  true  hereditary  gouty  diathesis  the  tendency  is  not 
towards  recovery,  but  towards  a  gradual  increase  in  the  fre- 
quency of  occurrence  and  severity  of  the  symptoms.  The 
vitality  of  the  trophic  centers  is  constitutionally  impaired,  and 
however  careful  the  victims  may  be  in  their  habits  of  living,  the 
majority  of  them  become  chronic  invalids  and  die  of  nephritis, 
apoplexy,  or  some  other  gouty  finale,  after  months  and  some- 
times years  of  suffering. 

As  far  as  we  know,  however,  the  neuralgias,  dyspepsias, 
hemorrhoids,  chronic  bronchitis,  etc.,  of  lithaemia  and  the  true 
gouty  diathesis,  in  its  early  stages  at  least,  are  due  to  the  self- 
same direct  etiological  factor,  suboxidation.  Confirmatory  of 
this  view  is  the  fact  that  all  the  measures  which  have  ever 
been  productive  of  anything  like  permanently  satisfactory 
results  in  these  conditions  have  had  increase  of  metabolism, 
i.  e.,  oxidation,  as  one  of  their  prominent  effects,  or  decrease 
of  the  matter  ingested,  which  would  put  an  undue  burden 
upon  the  oxidative  capabilities  of  the  organism,  as  their  object. 
Regulation  of  diet,  combined  with  judiciously-directed  exer- 
cise, has  always  been  the  sheet  anchor  in  treatment. 

Chemical  experiment  and  clinical  experience  have  also  shown 
that  increasing  the  alkalinity  of  the  blood  renders  more  soluble 
and  hence  more  susceptible  of  excretion,  the  suboxidized  prod- 
ucts present  in  lithnemic  subjects,  and  the  alkali-lithia  prepara- 


226  Therapeutics  of  Dry  Hot  Air. 

tions  have  gained  reputation  in  the  treatment  of  the  condition 
because  of  their  capacity  for  accomplishing  this  end.  The  large 
amount  of  water  which  accompanies  their  administration  also 
facilitates  removal  of  the  offending  matters  by  its  solvent  in- 
fluence in  the  tissues  of  the  body,  and  its  diuretic  effect  upon 
the  kidney. 

Therapeutic  Indications. — From  the  foregoing  it  will  be 
seen  that  the  management  of  lithsemia  resolves  itself  into  the 
employment  of  measures  tending  to  secure,  first,  a  limitation  of 
the  nitrogenous  matter  ingested;  second,  an  increase  in  the 
oxidation  processes  whereby  waste  products  retained  in  the 
blood  and  tissues  may  be  rendered  more  susceptible  of  excre- 
tion ;  and,  third,  a  rehabilitation  of  the  trophic  nerve  centers, 
functional  impairment  of  which  has  maintained  the  derange- 
ment of  metabolism  throughout  the  organism. 

Diet. — The  first  object  is  obtained  by  regulating  the  ingesta 
according  to  well-known  rules,  and  the  daily  ingestion  of 
plenty  of  pure  water,  at  least  a  quart  per  day,  should  constitute 
an  unvarying  element  in  the  management  of  every  case. 

General  Dry  Hot  Air  Application. — For  the  attainment 
of  the  second  there  is  no  measure  equal  to  the  body  dry  hot 
air  treatment,  either  in  efficiency  or  rapidity.  We  have  already 
noticed  its  powerful  influence  in  stimulating  metabolism,  and 
in  rehabilitating,  reconstructing,  and  invigorating  an  exhausted 
nervous  system,  hence  a  mere  mention  of  the  facts  will  suffice 
here.  One  other  effect  of  the  body  dry  hot  air  treatment  which 
merits  consideration  here,  however,  has  not  been  specifically 
referred  to  before,  and  that  is  its  power  to  increase  the  alkalin- 
ity of  the  blood.  As  noted  previously,  increase  in  alkalinity  is 
very  helpful  in  transforming  the  insoluble  products  of  imper- 
fect oxidation  into  soluble  forms  which  are  susceptible  of  ex- 
cretion. This  it  accomplishes  through  the  profuse  perspiration 
induced,  which  is  strongly  acid  in  reaction.  The  rapid  with- 
drawal of  such  a  large  quantity  of  fluid  from  the  body  also 
plays  no  small  part  in  the  general  metabolic  stimulation  excited, 
by  reason  of  increase  in  volume  and  rate  of  the  circulation  in  all 
the  tissues  of  the  body.  In  this  connection  it  acts  the  same  as 
general  massage,  but  much  more  profoundly. 


Gout.  227 

Elevation  of  the  body  temperature  is  rarely,  if  ever,  present 
in  uncomplicated  lithaemia,  hence  the  technique  of  the  body 
treatment  is  simple,  and  has  been  fully  described  in  the  section 
devoted  to  that  subject.  Modification  will  be  required  only 
with  those  patients  whose  arteries  have  become  atheromatous, 
and  then  only  to  the  extent  of  using  a  less  intense  degree  of 
heat  and  running  it  up  more  slowly  for  the  first  three  or  four 
seances.  The  degree  of  heat  eventually  attained  should  be  at 
least  350°  F.,  and  the  time  period  of  the  application  should 
depend  upon  the  pulse  acceleration  and  the  degree  of  hyper- 
thermia  induced. 

Electricity  and  Hydrotherapy. — Other  physical  measures 
which  are  efficient  in  removing  the  primary  pathology  of 
lithaemia  are  the  static  electrical  modalities,  hydrotherapy,  and 
the  radiant  heat  bath,  but,  in  the  writer's  experience,  no  one 
of  them  has  equaled  body  dry  hot  air  applications.  The  static 
modalities  are  of  very  great  assistance  in  combination  with  it, 
however. 

Drugs. — The  mineral  waters  and  salines  are  the  best  agents 
to  employ  against  the  constipation  which  is  usually  present,  and 
this  condition  should  invariably  be  looked  to.  Free  action 
of  the  bowels  is  of  the  utmost  importance  in  lithaemia. 

Immediate  symptoms,  such  as  neuralgia,  indigestion,  irritable 
bladder,  etc.,  will  rarely  call  for  special  attention  after  the 
first  week  of  dry  hot  air  treatments,  but  when  they  do  their 
management  does  not  differ  from  that  ordinarily  applicable. 

Exercise.— Judiciously-regulated  exercise  is  a  necessary  ac- 
companiment of  any  management  of  this  disease. 

Gout. 

It  is  not  inappropriate  in  this  connection  to  say  a  word  about 
the  use  of  dry  hot  air  in  true  gout.  True  gout  is  not  common  in 
this  country,  and  the  writer  has  had  very  little  experience  with 
the  agent  in  this  disease.  Our  transatlantic  colleagues  see  a 
deal  of  it,  however,  and  some  of  them  speak  highly  of  the  use 
of  dry  hot  air  in  its  treatment.  Walsh,  of  Edinburgh,  Scot- 
land, has  used  it  a  good  deal,  and  reports  as  follows: 

"  The  present  writer  has  witnessed  remarkable  results,  fol- 


228  Therapeutics  of  Dry  Hot  Air. 

lowing  the  application  of  the  superheated  air  in  gouty  cases. 
It  will  control  even  acute  gout,  and  in  one  case  an  incipient 
attack  in  the  great  toe  was  treated  with  so  much  success  that 
the  patient,  a  stockbroker,  was  enabled  to  keep  his  engagement 
at  a  shooting  party  next  day.  That  result  will  speak  volumes 
to  all  who  are  familiar  with  acute  gout.  In  advanced  and- 
chronic  cases  the  restoration  of  movement  and  return  to  health 
has  often  been  of  a  most  striking  nature.  Under  the  super- 
heated air  uratic  deposits  and  enlarged  bursae  often  vanish. 

"  A  somewhat  extensive  experience  has  convinced  the  present 
writer  that  the  Tallerman  method  yields  curative  results  in  gout 
that  cannot  be  approached  by  other  therapeutic  measures." 

It  would  seem  that  the  physiological  action  of  dry  hot  air, 
especially  of  the  general  application,  was  particularly  well 
adapted  to  remove  the  pathological  conditions  obtaining  in  true 
gout,  and  the  hope  that  it  may  prove  to  be  of  value  upon  fur- 
ther acquaintance  seems  justified  by  what  is  known  of  its  prac- 
tical clinical  effects. 

NEURALGIA. 

In  the  treatment  of  no  condition  is  the  correct  diagnosis  of 
causative  factors  more  essential  than  in  that  of  the  various 
neuralgias.  As  the  scope  of  this  article  does  not  include  diag- 
nosis, the  truth  of  the  above  statement  will  merely  be  indicated 
by  calling  attention  to  the  fact  that  neuralgia  may  be  provoked 
by  a  variety  of  causes,  prominent  among  them  being  general 
debility,  resulting  in  impaired  nutrition  of  certain  nerve  trunks ; 
the  presence  of  abnormal  substances  in  the  blood,  as  exempli- 
fied by  the  neuralgias  accompanying  lithaemia,  plumbism,  the 
excessive  use  of  tobacco,  and  the  infectious  fevers;  certain 
degenerative  processes  in  the  spinal  nerve-tracts;  degenerative 
changes  in  the  nerve  trunks  themselves,  and  pressure  from 
tumors.  Another  rare  cause  is  disease  of  some  of  the  internal 
organs,  which  produces  the  sensation  of  pain  in  the  remote 
distribution  of  a  nerve  trunk,  the  pain-conducting  fibers  of 
which  are  so  situated  in  the  cord  as  to  be  susceptible  of  in- 
fluence by  pain  impulses  traversing  the  nerve  supply  of  the 
affected  organ,  the  so-called  "  referred  pains." 


Neuralgia.  229 

Treatment. 

Dry  hot  air  enters  the  problem  in  two  ways ;  it  is  efficient  in 
removing  some  of  the  primary  causes  in  the  form  of  the  body 
treatment,  and  in  mitigating  the  local  condition  in  the  form  of 
the  local  application.  I  will  say  here  that,  as  the  agent  cannot 
be  applied  directly  to  the  head,  it  is  useful  in  cephalalgia  only 
when  this  is  dependent  upon  some  systemic  condition  which  is 
amenable  to  the  influence  of  an  application  to  the  general  body 
surface. 

General  Dry  Hot  Air  Application. — In  the  neuralgias  of 
general  debility,  body  dry  hot  air  treatments  are  of  tran- 
scendent value.  The  pains  usually  lessen,  and  sometimes  dis- 
appear entirely  during  the  first  seance  while  the  patient  is  in  the 
apparatus,  and  not  infrequently  the  removal  is  permanent.  Its 
influence  in  this  situation  is,  of  course,  due  to  stimulation  of 
the  trophic  processes  throughout  the  body,  and  the  determina- 
tion of  a  large  quantity  of  blood  laden  with  nourishment  to 
the  starving  nerve. 

Neuralgias,  due  to  the  presence  of  abnormal  substances  in 
the  blood,  will  nearly  always  yield  temporarily  to  local  treat- 
ments when  in  accessible  situations,  but  their  radical  removal 
will  usually  demand  the  body  application.  This  acts,  of  course, 
through  its  power  of  inducing  rapid  elimination,  as  well  as 
sedation  of  nerve  irritation  and  acceleration  of  normal  metab- 
olism. Enough  work  has  not  yet  been  done  with  it  in  the 
neuralgias  accompanying  the  infectious  fevers  to  make  reliable 
conclusions  possible,  but  the  data  now  at  our  command 
would  indicate  that  it  possesses  some  usefulness  in  this  con- 
nection. 

Local  Dry  Hot  Air  Application. — When  the  painful  part 
is  accessible,  as  the  intercostal  nerves  for  instance,  and  the 
primary  cause  is  a  general  debility,  the  local  application  will 
almost  always  relieve  at  once,  and  sometimes  the  result  is  most 
happy  as  to  permanence.  The  writer  has  seen  an  intercostal 
neuralgia  of  fifteen  years'  standing  entirely  cured  by  three  local 
dry  hot  air  treatments. 

This  measure  will  sometimes  also  afford  temporary  relief  in 


230  Therapeutics  of  Dry  Hot  Air. 

pain  affecting  the  distribution  of  nerves  pressed  upon  by 
tumors,  but  only  removal  of  the  primary  cause,  of  course,  will 
result  in  permanent  cure. 

The  technique  of  both  body  and  local  treatments  in  neuralgia 
is  simple,  and  has  been  fully  described  in  Chapter  III. 

Electricity. — The  electrical  modalities,  especially  those  de- 
rived from  the  static  machine,  vie  with  dry  hot  air  in  the  treat- 
ment of  neuralgias,  and  in  some  situations,  as  about  the  head, 
supplant  it  entirely  in  most  cases.  Where  it  is  appropriate, 
much  greater  convenience  of  administration  makes  it  preferable 
to  hot  air,  and  it  is  always  of  value  in  connection  with  it.  Tem- 
porary relief  of  pain,  at  least,  can  almost  always  be  secured  by 
electrical  applications,  and  cases  of  even  the  intractable  "  tic- 
douloureux  "  have  been  reported  as  cured  by  them.  The  writer 
has  never  seen  a  case  of  true  "  tic,"  however,  in  which  anything 
short  of  resection  of  the  nerve  or  total  removal  of  the  gasserian 
ganglion  afforded  complete  and  permanent  relief,  but  it  is  some- 
times a  matter  of  great  comfort  to  be  able  to  afford  the 
sufferers  even  short  respites  without  operation.  Dry  hot  air 
has  so  far  scored  no  successes  in  this  affection. 

Drugs. — The  medicinal  treatment  appropriate  to  the  various 
primary  conditions  causing  neuralgias  should  accompany  the 
physical  measures,  and  the  final  result  is  much  hastened  there- 
by ;  neither  alone  will  accomplish  the  results  attainable  with 
both  together.  As  indicated  previously,  surgery  will  also  have 
to  be  called  upon  at  times  to  extirpate  exciting  causes,  as 
tumors,  etc. 

Myalgia. 

This  affection  is  really  a  neuralgia  affecting  the  nerve  fibers 
ramifying  in  a  muscle.  It  is  usually  due  to  systemic  toxaemia  of 
some  sort,  and  the  treatment  is  the  same  as  for  neuralgia  in 
other  situations.  The  static  wave  current  or  spark  will  usually 
alleviate  the  pain  more  rapidly  and  thoroughly  than  any  other 
measure,  and  dry  hot  air  applications,  both  local  and  general, 
stand  pre-eminent  among  the  means  for  removing  both  imme- 
diate symptoms  and  primary  causes. 


Varicose  Ulcers.  231 

VARICOSE   ULCERS. 

Varicose  ulcers  are  directly  due  to  impairment  of  the  local 
nutritive  function,  but  this,  in  turn,  is  due  to  constitutional 
debility  or  degeneration  of  some  sort,  and  atheroma,  the  gouty 
diathesis,  and  lithsemia  play  an  important  part  as  predisposing 
conditions  in  many  cases.  The  direct  etiological  factor  is 
most  frequently  traumatism,  the  effects  of  which  the  crippled 
circulatory  function  is  unable  to  repair. 

Treatment. 

Local  Dry  Hot  Air  Applications. — Local  applications  of 
dry  hot  air  constitute  one  of  the  most  effective  single  measures 
known  for  the  local  management  of  the  condition,  and,  in  ordi- 
nary cases,  will  effect  a  cure  in  from  three  to  six  weeks.  The 
cure  will  not  usually  be  permanent,  however,  unless  the  con- 
stitutional conditions  upon  which  the  local  lesion  depends  are 
also  removed  or, lessened. 

The  technique  is  that  usual  to  the  local  treatment,  except 
that  the  temperature  rarely  need  be  higher  than  300°  F.  The 
frequency  of  application  will  depend  entirely  upon  how  the  sore 
responds.  At  the  beginning  it  should  be  applied  every  other 
day.  If  no  improvement  is  noted  at  the  end  of  ten  days 
it  may  be  increased  to  every  day.  When  an  appropriate  con- 
stitutional treatment  has  accompanied  the  local  dry  hot  air 
applications,  the  case  will  be  a  rare  one  which  does  not  exhibit 
marked  improvement  in  three  weeks. 

General  Dry  Hot  Air  Applications. — It  is  always  wise, 
and  sometimes  necessary,  to  administer  the  body  treatment 
once  or  twice  weekly  to  patients  suffering  from  varicose  ulcers. 
We  have  already  considered  the  different  phases  of  its  physio- 
logical action,  hence  it  is  only  necessary  to  recall  the  constitu- 
tional etiology  of  varicose  ulcer  in  order  to  appreciate  the 
manner  in  which  the  body  treatment  is  beneficial. 

Electricity. — The  electrical  modalities  alone  are  of  great 
assistance  in  the  management  of  the  condition  under  consider- 
ation, but,  in  combination  with  dry  hot  air,  their  effectiveness 
is  doubled. 

The  negative  pole  of  the  galvanic  battery,  applied  directly 


232  Therapeutics  of  Dry  Hot  Air. 

to  the  ulcerating  surface  with  from  two  to  ten  milliamperes  of 
current  according  to  the  patient's  tolerance,  is  extremely  effect- 
ive in  producing  repair  of  the  local  lesion.  Enough  current 
to  cauterize  should  not  be  used.  Electrolysis  is  what  does  the 
work,  and  cauterization  will  but  hinder  progress. 

The  static  wave  current  localized  upon  the  sore  is  nearly  as 
effective  as  galvanism,  and  possesses  the  advantage  of  exert- 
ing a  marked  constitutional  influence  for  good.  The  brush  dis- 
charge is  also  very  effective,  in  some  cases  appearing  to  do 
even  better  work  than  the  wave  or  galvanism.  Sparks  to  the 
ulcer  enjoy  something  of  a  reputation  as  a  curative  measure, 
but  the  writer  has  seen  ulcers  that  were  attempting  to  heal  re- 
peatedly break  down  again  under  their  application,  and  has 
abandoned  them  entirely  in  this  connection.  The  high  fre- 
quency current  bids  fair  to  prove  useful,  but  it  has  not  yet  been 
used  enough  to  make  reliable  conclusions  possible. 

Drugs  and  Surgical  Dressings. — The  administration  of 
appropriate  drugs  for  their  constitutional  effect,  and  the  appli- 
cation of  appropriate  antiseptic  dressings,  should  always  ac- 
company the  physical  measures,  but  strapping  or  other  stimu- 
lating measures  are  entirely  uncalled  for. 

OTITIS. 

Hopkins,  of  Cleveland,  O. ;  Beck  and  Oaks,  of  Chicago,  111. ; 
Schloss,  of  San  Francisco,  Cal. ;  Sverzhevsky,  of  Moscow. 
Russia,  and  others  have  reported  very  good  results  from  the 
use  of  dry  hot  air  in  affections  of  the  ear.  The  author  has  had 
no  experience  with  the  agent  in  this  situation,  and  the  follow- 
ing is  extracted  from  one  of  Dr.  Hopkins'  excellent  articles 
upon  the  subject.  The  case  reported  below  had  remained  well 
for  five  years  at  the  time  of  publication,  and  was  treated  with 
a  very  crude  apparatus,  instead  of  the  modern  finished  product 
described  in  the  chapter  upon  "  Apparatus." 

"  The  patient,  John  L.,  aged  fifty-three,  a  carpenter,  with  ex- 
cellent family  and  personal  history,  has  never  been  seriously 
ill,  but  has  had  nasal  catarrh  for  fifteen  years,  and  gradually 
increasing  deafness  for  ten  years. 

"  Examination    revealed    a    typical    case    of    hypertrophic 


O  tit  is.  233 

rhinitis.  The  watch  tick  could  be  faintly  heard  with  the  watch 
in  very  close  contact  with  the  left  ear.  The  tick  could  be 
heard  to  a  distance  of  three  inches  from  the  right  ear.  The  left 
ear  was  selected  for  the  test. 

''  Diagnosis :  Chronic  catarrhal  otitis  media,  with  sclerosis 
ana  displacement  of  the  tympanum,  anchylosis  of  the  ossicles, 
slight  dilatation  of  the  Eustachian  tube,  and  some  labyrinthine 
involvement. 

"  The  diagnosis  was  confirmed  by  two  colleagues  of  reputa- 
tion as  aurists  before  treatment  was  instituted.  Regular,  sys- 
tematic treatment,  continued  for  two  years,  before  this  experi- 
ment was  made,  had  scarcely  stayed  the  progress  of  this  disease. 

"  Treatment :  The  ear  was  thoroughly  cleansed  with  alcohol 
for  several  days  before  treatment  was  instituted.  The  patient 
was  then  seated  in  a  comfortable  chair,  the  ear  examined  and 
found  perfectly  clean.  Narrow  strips  of  dry  gauze  were  placed 
into  the  ear,  and  a  large  pad  of  dry  gauze  placed  over  the  ear. 
The  ear  was  then  covered  with  a  canvas  sleeve  hot  air  con- 
ductor, and  a  current  of  air  sent  into  the  canal  at  a  temperature 
which  gradually  attained  400°  F. 

"  The  temperature  was  easily  borne,  if  gradually  increased, 
until  a  high  point  was  reached ;  the  only  discomfort  attending 
the  treatment  arising  from  a  severe  headache  which  followed  it, 
but  which  was  promptly  relieved  by  a  dose  of  codein. 

"  Following  the  hot  air  treatment,  the  Eustachian  tube  was 
always  inflated  with  a  warm  stimulating  vapor  from  a  Globe 
nebulizer,  vibratory  massage  with  the  nebulizer  completing  the 
treatment. 

"  The  patient  was  not  allowed  to  leave  the  office  for  a  half- 
hour  after  treatment,  and  the  ear  was  tightly  packed  with  warm 
cotton  before  he  went  out. 

"  The  nose  and  pharynx  received  appropriate  treatment  with 
antiseptic  washes,  etc. 

"  Treatments  were  continued  on  alternate  days  for  three 
months,  at  the  end  of  which  time  he  could  hear  the  watch  tick 
distinctly  at  thirty-four  inches,  and  surprised  his  friends  by  in- 
variably replying  to  their  whispered  references  to  him. 

"  The  right  ear  was  then  similarly  treated,  and  in  ten  weeks 
an  equally  good  result  was  secured. 

"  Examination  showed  that  the  ears  were  normal  in  appear- 
ance. The  patient  was  discharged  January  6,  1897,  and  careful 
tests  made  at  frequent  intervals  since  have  shown  no  tendency 
to  recurrence. 

"  As  to  the  philosophy  of  such  a  cure  by  this  agency,  little  can 
be  said  at  this  time,  but  it  seems  certain  that  the  intense  heat 


234  Therapeutics  of  Dry  Hot  A  ir. 

stimulates  the  circulation  through  the  blood  supply  on  the  pos- 
terior side  of  the  manubrium,  causing  absorption  of  the  articu- 
lar deposits,  removing  atrophy  and  relieving  the  rigidity  of  the 
tensor  tympani.  The  ossicles  lie  so  near  the  surface  that  they 
receive  the  full  benefit  of  heat  applied  to  the  tympanum,  and 
adhesions  between  portions  of  the  ossicular  chain  and  the  ad- 
joining bony  walls  of  the  middle  ear  are  readily  removed. 

"  Naturally,  much  better  results  are  secured  in  the  same 
period  of  time  in  hypertrophic  cases  than  in  those  characterized 
by  hyperplasia ;  but  many  cases  of  the  latter  type,  which  would 
ordinarily  have  been  regarded  as  hopeless,  have  gradually  im- 
proved under  this  treatment  until  marked  benefit  was  secured. 

"  As  to  the  results  which  may  reasonably  be  expected  from 
the  judicious  and  skillful  employment  of  the  agency  with  good 
appliances  in  cases  of  chronic  catarrhal  otitis  media,  it  may  be 
said: 

"  (i)  That  as  an  exclusive  treatment  it  is  rarely  of  much 
value  in  bad  cases. 

"  (2)  That  when  indicated  and  judiciously  employed,  in  con- 
junction with  other  measures  of  recognized  value,  it  will  give 
results  which  would  be  utterly  impossible  without  its  aid. 

"  (3)  That  when  employed  with  care  it  is  absolutely  safe 
unless  contra-indicated. 

"  (4)  That  it  is  of  little  value  in  old  subjects  who  have  ex- 
tensive labyrinthine  involvement. 

"  (5)  That  it  stimulates  absorption  of  articular  deposits,  re- 
moves atrophy,  and  relieves  rigidity  of  the  tensor  tympani. 

"  (6)  That  it  acts  more  favorably  on  the  ossicular  chain 
than  on  many  other  articulations,  because  of  the  exceptional 
proximity  to  the  surface. 

"  (7)  That  arteriosclerosis  and  serous  effusions  into  the 
tympanum  are  usually  centra-indications,  and  always  contra- 
indications to  the  inexperienced  operator." 

The  technique  of  dry  hot  air  applications  to  the  external 
auditory  canal  is  fully  described  in  the  appropriate  section  of 
Chapter  III.  Dr.  Hopkins  speaks  of  the  use  of  additional 
remedial  measures  as  follows: 

"  Every  case  must  be  treated  as  a  whole.    He  who  neglects 


Otitis.  235 

the  appropriate  treatment  of  the  naso-pharynx  is  doomed  to 
disappointment. 

"  Antiseptic  washes  must  be  used.  All  abnormal  conditions 
must  be  rationally  treated.  Constitutional  measures,  when  in- 
dicated, must  not  be  neglected.  Inflation  of  the  Eustachian 
tube  with  a  warm,  stimulating  vapor  from  some  good  apparatus 
like  the  Globe  nebulizer  is  usually  imperative. 

"  It  is  well  to  practice  Eustachian  inflation  and  vibratory 
massage  of  the  middle  ear  with  medicated  vapor  from  the 
nebulizer  after  each  hot  air  treatment,  being  particular  that  the 
vapor  is  warm.  A  warm  vapor  is  easily  secured  by  connecting 
the  compressed  air  heater  in  service  with  the  nebulizer,  send- 
ing the  compressed  air  first  through  the  heater  and  then 
through  the  nebulizer. 

"  Careful  attention  to  all  details  brings  most  gratifying  suc- 
cess in  the  form  of  gradually  and  steadily  improved  hearing 
and  gradual  disappearance  of  tinnitus. 

"  A  single  detail  neglected  may  cause  absolute  failure." 


CHAPTER  XL 
MISCELLANEOUS    CONDITIONS. 

Nervous  Debility  and  Exhaustion. 

The  condition  meant  here  is  the  neurasthenia  due  solely  to 
excessive  nerve  strain,  and  is  encountered  in  individuals  who 
have  overworked,  and  sometimes  in  women  who  are  passing 
the  climacteric. 

The  object  to  be  obtained  by  treatment  is  the  reinvigoration 
of  nervous  tissue,  which  has  become  exhausted  to  an  unman- 
ageable degree  of  irritability  and  functional  impairment,  by  the 
production  of  new  cells  which  are  capable  of  normal  function. 
This  can  only  be  done  by  calling  into  activity  the  metabolic 
functions  concerned  in  nutrition.  As  we  have  seen,  the  body 
dry  hot  air  treatment  stands  pre-eminent  as  a  stimulant  to 
metabolism,  and  would  seem  to  be  an  ideal  measure  for  the 
removal  of  nerve  debility  of  any  degree ;  experience  proves  it 
to  be  very  useful  in  this  field.  When  the  patient  comes  under 
treatment  before  the  debility  has  become  an  exhaustion,  it  is 
not  necessary  for  him  to  stop  work  entirely  even.  One  or  two 
body  treatments  a  week  with  a  strychnia  tonic  will  usually  re- 
store him  to  health  in  short  order. 

When  the  initial  condition  has  been  neglected  or  inefficiently 
treated,  however,  and  the  point  of  exhaustion  has  been  reached, 
the  problem  assumes  a  different  aspect  both  as  to  management 
and  duration.  The  most  prominent  symptoms  now  exhibited 
are  insomnia,  more  or  less  melancholia  usually,  inability  to  fix 
the  mind  upon  any  one  subject  for  any  length  of  time,  physical 
exhaustion  upon  slight  exertion,  all  sorts  of  aberrations  in  the 
sensory  sphere,  and  gastric  and  intestinal  indigestion. 

The  last-mentioned  phenomena,  primarily  due  to  impairment 
of  the  nerve  centers  controlling  the  digestive  ferment-produc- 
ing glands,  react  upon  the  organism  by  throwing  into  the 

236 


Nervous  Debility  and  Exhaustion,  237 

blood    current    imperfectly    metabolized    substances,    thereby 
maintaining  the  depression  of  the  central  nervous  system. 

Usually  the  first  thing  to  do  now  is  to  secure  a  complete 
change  in  the  patient's  surroundings  and  mental  habits,  by  re- 
moving him  from  his  home  and  placing  him  in  an  environment 
which  will  admit,  as  nearly  as  possible,  of  entire  freedom  from 
care  and  undue  physical  and  mental  exertion.  Supply  him 
plentifully  with  plain,  nutritious,  easily-digested  food,  selected 
according  to  the  idiosyncrasies  of  the  individual  case,  and  give 
him  a  body  dry  hot  air  treatment  two  or  three  times  a  week.  A 
judicious  amount  of  exercise  is  also  very  beneficial  in  most 
cases. 

Static  and  high  frequency  electricity  are  most  useful,  in 
combination  with  dry  hot  air,  in  all  grades  of  neurasthenia,  and 
their  beneficial  influence  is  not  looked  upon  as  due  entirely  to 
suggestion  by  those  who  have  used  them  very  extensively. 
The  wave  current,  localized  over  the  solar  plexus  in  the  morn- 
ing, and  over  the  spine  in  the  evening,  and  auto-condensation 
three  times  weekly,  are  the  most  useful  of  the  modalities. 
When  the  nervous  condition  has  improved  some,  static  sparks 
may  be  applied  over  the  spine  and  general  surface  of  the  body, 
preferably  in  the  morning.  On  the  days  when  dry  hot  air  is 
administered,  one  of  the  electrical  treatments  may  be  omitted. 
The  combination  of  these  three  measures,  with  galvaniza- 
tion of  the  brain  and  spinal  cord  twice  weekly,  and  regulation  of 
the  gastric  and  intestinal  functions,  has  given  me  more  satis- 
faction in  the  treatment  of  uncomplicated  neurasthenia  than 
any  other  measure  that  I  have  ever  used. 

The  electric  arc  and  incandescent  light  baths  are  very  highly 
spoken  of  by  Kellogg  and  others,  and  the  physiological  action 
of  radiant  heat  constitutes  a  logical  and  seemingly  strong  evi- 
dence favoring  its  employment  in  this  condition.  Its  efficiency 
as  compared  with  other  physiological  methods  of  management, 
however,  is  a  matter  to  be  decided  in  the  future. 

General  Debility  and  the  Convalescent  State. — It  may  not 
be  amiss  to  mention  in  this  connection  that  recovery  from  any 
simple  general  debility,  and  convalescence  from  the  acute  ex- 
hausting diseases,  such  as  pneumonia  and  typhoid,  and  which, 


238  Therapeutics  of  Dry  Hot  Air. 

especially  in  the  latter,  is  sometimes  greatly  prolonged,  may  be 
hastened  in  the  most  gratifying  manner  by  the  use  of  body 
dry  hot  air  treatments,  electricity,  and  mechanical  vibratory 
stimulation. 

Pulmonary  Tuberculosis. 

The  only  therapeutical  measures  that  have  been  proven  to 
be  of  substantial  benefit  in  consumption  are  those  that  improve 
the  general  condition  and  increase  the  nutritional  processes  of 
the  patient.  As  we  have  seen,  the  administration  of  one  or  two 
body  dry  hot  air  treatments  a  week  is  very  efficient  for  this 
purpose,  and  it  is  my  belief  that  this  measure  will  play  a  not 
unimportant  part  in  the  treatment  of  this  disease  in  the  future. 
The  establishment  of  tuberculosis  sanitaria  throughout  the 
country,  and  for  that  matter  throughout  the  world,  is  attract- 
ing daily  more  and  more  favorable  attention,  and  the  realization 
of  this  most  desirable  method  of  handling  the  disease  is  prob- 
ably not  far  away.  In  institutions  of  this  character,  where  the 
environment  of  the  patient,  his  daily  habits,  etc.,  would  be  care- 
fully arranged  and  directed  so  as  to  secure  the  most  favorable 
conditions  possible  for  his  improvement,  dry  hot  air  could  be 
administered  so  as  to  utilize  all  of  its  powers. 

I  have  not  subjected  many  patients  to  this  treatment,  because 
the  climatic  conditions  obtaining  in  this  region  are  among  the 
worst  possible  for  such  cases.  I  always  send  them  away  imme- 
diately, when  they  can  go.  Some  are  not  able  to  go,  however, 
and  then  we  have  to  do  the  best  we  can  under  the  circum- 
stances. 

Although  dry  hot  air  has  not  cured  any  of  the  patients  that 
I  have  had  under  observation,  yet  it  has  done  a  great  deal  in 
the  way  of  increasing  strength  and  improving  the  general  con- 
dition. The  appetite  and  assimilation  of  food  have  been  im- 
proved, whereby  a  diminution  of  the  rapidity  of  progress  of 
the  disease  has  been  secured  and  life  prolonged.  I  have  seen 
a  patient  who  was  so  weak  when  brought  under  treatment  that 
she  would  consume  half  an  hour  in  ascending  a  flight  of  twenty 
stairs,  and  who  could  accomplish  scarcely  more  than  that  many 
steps  on  the  level  without  sitting  down  to  rest,  improve  in  a 
month  to  such  an  extent  that  she  was  able  to  ascend  two  flights 


Pulmonary  Tuberculosis.  239 

of  stairs  without  stopping,  and  could  go  off  and  take  trolley 
rides  alone  by  herself.  Dry  hot  air  appreciably  lessens  the 
cough,  the  patient  sleeps  better,  feels  better,  and  usually  gains 
some  in  weight.  After  the  first  period  of  improvement,  how- 
ever, the  patient  begins  slowly  to  fail  again,  and  continues 
steadily  so  to  do  until  the  usual  termination  obtains.  These 
observations  apply  only  to  advanced  cases,  as,  for  reasons 
previously  stated,  I  have  never  subjected  an  incipient  case  to 
the  treatment. 

It  has  been  suggested  that  the  improvement  observed  was 
due  to  psychical  influence,  but  I  do  not  consider  this  explana- 
tion to  be  the  true  one.  It  is  an  undoubted  fact  that  a  con- 
sumptive will  improve  generally  for  a  short  time  under  any 
new  line  of  treatment,  but  the  improvement  does  not  continue 
steadily  for  from  six  to  eight  weeks  and  is  not  accompanied  by 
gain  in  weight,  lessening  of  cough  and  expectoration,  etc.,  as 
is  the  case  when  body  dry  hot  air  treatments  are  administered. 
The  improvement  dependent  upon  psychical  influence  usually, 
in  my  experience,  has  lasted  about  one  and  rarely  more  than 
three  weeks,  after  which  the  patient's  condition  is  all  at  once 
as  bad  as  ever  again.  When  the  decline  begins  again  after  the 
improvement  from  dry  hot  air  treatments,  it  is  slow  and 
gradual,  showing  constantly  decreasing  systemic  resistance, 
and  sometimes  it  requires  two  or  three  months  to  reduce  the 
victim  to  the  condition  which  he  was  in  before  beginning 
treatment.  Judiciously  and  thoroughly  administered  body  dry 
hot  air  treatments  are  worthy  of  extended  trial  under  favorable 
climatic  and  hygienic  conditions  in  pulmonary  tuberculosis. 

The  local  application  of  this  agent  is  most  satisfactory  for 
dealing  with  the  secondary  pleurisies  of  tuberculosis,  and  a 
certain  amount  of  general  benefit  follows  its  use.  At  first  sight 
it  would  seem  as  if  we  might  expect  the  same  benefit  to  follow 
its  use  in  consumption  as  in  pneumonia,  but  experience  does 
not  bear  out  the  inference.  We  have  in  phthisis  a  condition 
similar  to  that  obtaining  in  central  pneumonia,  as  far  as  the 
bulk  of  the  pathological  tissue  is  concerned,  viz.,  the  foci  of 
infection  are  separated  from  the  dry  hot  air  apparatus  by 
layers  of  functionating  air-cells.  Across  these,  as  in  central 


240  TJierapeutics  of  Dry  Hot  Air. 

pneumonia,  it  is  of  course  impossible  to  conduct  the  heat ; 
hence  the  infected  tissues  cannot  be  reached.  The  heat  can 
easily  be  conducted  to  the  pleurae,  however,  and  the  rapid  and 
satisfactory  manner  in  which  the  local  application  extinguishes 
these  painful  and  debilitating  secondary  outbreaks  of  the  infec- 
tion, is  a  source  of  great  comfort  to  the  physician  as  well  as  to 
the  patient. 

X-light  passed  through  the  affected  lung  tissue  three  times 
weekly  has  apparently  produced  some  extremely  good  results 
in  tuberculosis.  Rudis-Jicinsky  has  reported  curing  sixteen  out 
of  a  series  of  twenty  cases  of  incipient  tuberculosis  pulmonalis 
by  this  method,  and  his  cases  had  remained  well  two  years 
after,  as  far  as  could  be  observed.  Grubbe,  Burdick,  and 
others  also  speak  most  encouragingly  of  its  use ;  still  other 
observers  have  not  had  such  a  large  percentage  of  cures.  The 
author  has  treated  three  cases  with  X-rays.  One  of  them 
improved  for  a  while  ;  another  continued  to  grow  slowly  worse, 
although  I  believe  that  the  rapidity  of  the  progress  of  the  dis- 
ease was  checked  somewhat ;  the  third  died,  showing  appar- 
ently no  effect  whatever  from  the  rays.  The  favorable  results 
that  have  been  attained,  however,  make  it  worth  while  to  give 
X-light  a  trial,  however  small  the  percentage  of  benefit  that 
might  be  obtained. 

The  inhalation  of  ozone,  generated  in  a  special  apparatus 
from  the  static  electrical  current,  is  spoken  of  most  highly  by 
some  observers,  but  it  has  not  yet  been  used  sufficiently  to  make 
a  reliable  judgment  possible.  The  writer  has  not  been  able 
to  convince  himself  that  appreciable  benefit  followed  its  use 
in  cases  under  his  observation. 

In  France  and  England  the  high-frequency  electrical  cur- 
rents have  been  reported  as  giving  most  excellent  results  and 
it  is  to  be  hoped  that  the  investigation  of  their  powers  in  this 
disease,  which  is  now  being  somewhat  extensively  carried  on, 
will  justify  the  hopes  that  have  been  raised  by  these  reports. 

The  general  nutritional  applications  of  static  electricity,  cod 

•liver  oil,  and  other  drug  tonics,  chief  among  which  may  be 

reckoned  strychnia,  as  well  as  every  other  known  means  of 

increasing  vitality  and  bodily  vigor,   should   be  used   in  the 


Chronic  Bronchitis.  241 

treatment  of  tuberculosis.  As  suggested  previously,  it  is  prob- 
able that  consumptives  will  in  the  near  future  be  taken  care  of 
in  specially  arranged  and  located  sanitaria,  where  all  of  these 
measures  can  be  applied  in  combination  and  to  the  greatest 
advantage,  and  not  until  then  can  we  hope  to  see  very  satis- 
factory curative  results,  in  a  large  proportion  of  cases,  follow 
the  use  of  the  remedial  measures  known  at  present. 

Chronic  Bronchitis. 

Another  disease  of  diverse  etiology.  When  due  to  general 
debility,  as  when  it  follows  after  la  grippe,  or  to  constitutional 
aberrations,  as  lithsemia  or  the  gouty  diathesis,  body  dry  hot 
air  treatments  are  very  effective  in  removing  it.  The  local 
application,  administered  as  for  pneumonia,  also  possesses  con- 
siderable value  in  its  treatment.  The  technique  of  either  treat- 
ment requires  no  special  modification.  The  general  tonic,  cor- 
rective, and  eliminative  influence  of  the  body  applications  are 
well  supported  here  again  by  general  applications  of  static  elec- 
tricity, the  wave  current  to  the  spine,  sparks  to  the  spine  and 
chest,  etc.,  but  the  inhalation  of  ozone  has  proven  to  be  some- 
thing of  a  disappointment  to  most  of  us.  It  is  of  benefit  in  some 
cases,  however,  and  should  always  be  tried  if  a  patient  is  not 
responding  well  to  other  measures. 

The  ordinarily-indicated  drugs  should  always  accompany  the 
physiological  measures.  In  this,  as  in  rheumatism  and  several 
other  diseases  that  have  been  noted,  the  physiological  measures 
render  the  drugs  active  by  so  influencing  the  organism  as  to 
remove  or  lessen  conditions  that  cause  medicinal  agents,  un- 
aided, to  be  inefficient.  Neither  alone  will  do  the  work  that 
can  be  accomplished  by  both  together,  and  non-tuberculous 
chronic  bronchitis  is  sometimes  intractable  enough  to  require 
all  the  resources  at  our  command  for  its  removal. 

Fibrous  Anchylosis. 

It  has  been  stated  that  this  condition,  when  occurring  in  the 
larger  joints,  was  not  amenable  to  the  corrective  influence  of 
dry  hot  air ;  this  statement  was  erroneous.  One  of  the  writer's 
early  cases  was  a  fibrous  anchylosis  of  the  knee,  occurring  in  a 
boy  of  eleven  years  of  age,  resulting  from  five  weeks'  con- 


242  Therapeutics  of  Dry  Hot  A  ir. 

finement  of  the  joint  in  a  splint  applied  for  a  fracture  of  the 
femur  immediately  above  the  condyles.  He  had  been  etherized 
when  the  fracture  was  put  up,  and  the  after-effect  was  so  pro- 
longed and  severe  that  his  parents  were  unwilling  to  have  the 
experience  repeated.  The  joint  was  exquisitely  sensitive,  how- 
ever, and  the  adhesions  could  not  be  forcibly  broken  up  except 
under  an  anaesthetic.  I  administered  fourteen  local  dry  hot 
air  treatments,  following  each  with  a  few  minutes  of  passive 
motion,  the  excursions  being  susceptible  of  a  little  increase  after 
each  successive  seance,  and  the  knee  regained  its  normal 
mobility.  Subsequent  experience  has  shown  that  the  body 
treatment  is  of  assistance  in  combination  with  the  local  appli- 
cation in  removing  this  condition.  Several  other  observers 
have  reported  cases  of  fibrous  anchylosis  in  which  this  agent 
effected  a  satisfactory  termination,  and  its  favorable  influence 
over  the  condition  is  established  beyond  question. 

The  local  treatment  should  be  applied  every  day  for  a  week, 
and  then  every  other  day  until  recovery  has  taken  place.  Five 
or  ten  minutes  of  passive  motion  should  follow  each  treatment, 
the  joint  being  flexed  as  much  as  possible  without  causing  the 
patient  undue  suffering.  If  troublesome  inflammatory  reaction 
follows  this  manipulation,  the  dry  hot  air  should  follow  instead 
of  precede  the  stretching  of  the  adhesions.  The  body  treatment 
two  or  three  times  weekly  will  greatly  hasten  the  absorption 
through  influence  exerted  upon  the  metabolic  functions. 

The  static  wave  current,  static  spark,  and  galvanism  are 
efficient  in  combination  with  this  agent  in  hastening  the  process, 
in  the  order  in  which  they  are  named.  Their  curative  power 
is  exerted  through  the  same  channels  as  that  of  dry  hot  air,  but 
here,  as  in  some  other  conditions,  it  is  much  less  profound, 
hence  not  so  effective  when  used  alone. 

Cholylithiasis. 

Dry  hot  air  will  not  relieve  the  pain  of  ordinarily  severe 
hepatic  colic,  and  I  know  of  nothing  but  morphine  that  will. 
Sometimes,  however,  the  formation  of  new  calculi  can  be  pre- 
vented by  the  use  of  body  treatments  in  combination  with 
electricity  and  the  administration  of  appropriate  drugs.  Th-? 


Cholylithiasis.  243 

result  is  attained  through  the  influence  of  the  measures  in 
correcting  the  impairment  of  liver  function,  by  reason  of  which 
impairment  cholesterin  crystals  are  deposited,  whereas  they 
should  normally  remain  in  solution.  The  following  is  a  case 
in  point : 

A  lady,  forty  years  old,  had  sustained  her  first  attack  of 
hepatic  colic  a  year  and  a  half  before  she  consulted  me.  She 
had  had  several  attacks  since  then,  and  the  interval  between 
them  had  never  been  more  than  three  months.  During  the  four 
months  preceding  her  consultation  with  me  they  had  prostrated 
her  about  once  every  four  weeks.  She  had  been  given  appro- 
priate drugs  and  her  diet  had  been  wisely  regulated,  but  no 
effect  was  evident  upon  the  calculus  formation.  The  attacks 
were  growing  more  frequent  and  more  severe.  Her  digestive 
and  assimilative  functions  were  greatly  impaired,  and  marked 
general  nervous  debility  was  present.  She  had  lost  twenty 
pounds  in  weight  during  the  preceding  six  months. 

She  was  admitted  to  the  sanitarium,  her  treatment  consisting 
of  body  dry  hot  air  applications  three  times  weekly,  galvaniza- 
tion of  the  spinal  cord  with  the  negative  electrode  over  the  solar 
plexus  twice  weekly,  and  static  electricity  twice  daily,  except 
on  the  days  when  dry  hot  air  or  galvanism  was  administered, 
when  one  of  the  static  applications  was  omitted.  The  static 
modalities  used  were  sparks  to  the  spine,  general  muscular  sur- 
faces of  the  body,  and  over  the  liver  and  gall-bladder  in  the 
morning,  and  the  wave  current  localized  over  the  liver  at  night. 
She  was  given  sodium  phosphate  in  five-gram  doses  three  times 
daily,  magnesium  sulphate  for  her  constipation  when  necessary, 
and  the  diet  was  restricted  to  plain,  easily  digested  food,  with 
meat  fats,  pastries,  and  sweets  carefully  eliminated. 

Her  general  condition  began  to  improve  immediately,  and 
continued  to  do  so  for  three  weeks.  She  then  began  to  com- 
plain of  premonitory  symptoms  of  an  attack  of  colic,  and  three 
days  later  was  prostrated  by  the  worst  seizure  of  the  sort  that 
I  have  ever  witnessed,  which  lasted  for  three  days.  Her  faeces 
were  washed  and  fifteen  calculi  recovered,  varying  in  size  from 
that  of  a  head  of  a  pin  to  that  of  a  pea. 

She  was  kept  under  the  same  treatment  for  three  weeks  more 
and  then  sent  home  for  two  weeks,  at  the  end  of  which  time 
she  was  admitted  for  another  course  of  three  weeks.  For  the 
following  six  months  she  was  given  two  weeks'  courses  of  the 
same  treatment  at  intervals  of  three  and  four  weeks.  She  had 
no  more  attacks,  and  her  general  condition  steadily  improved, 
until  at  the  end  of  that  time  she  felt  and  apparently  was 


244  Therapeutics  of  Dry  Hot  Air. 

entirely   well,   and  has  remained   so  ever   since,   a  period  of 
two  years. 

None  of  the  cases  have  yet  been  under  observation  long 
enough  to  demonstrate  whether  or  not  the  beneficial  results 
will  be  permanent,  but  the  outlook  would  seem  to  be  promising. 

Gangrene. 

Gangrene  is  commonly  due  to  a  cutting  off  of  the  circulation 
of  the  part  affected,  as  in  embolism ;  or  extensive  impairment  of 
the  nutrient  function  of  the  blood  vessels  supplying  the  part 
affected,  as  atheroma,  and  exemplified  in  senile  gangrene  of  the 
extremities.  The  condition  also  obtains  occasionally  in  some 
grave  constitutional  diseases,  as  diabetes  mellitus. 

Dry  hot  air  treatments,  both  body  and  local,  are  of  great 
assistance  in  combating  gangrene,  and,  as  would  be  expected 
from  the  character  and  profundity  of  its  physiological  action, 
the  body  treatment  is  most  efficient.  That  the  local  treatment 
alone  is  capable  of  removing  the  affection  most  satisfactorily  in 
some  cases,  however,  is  demonstrated  by  the  result  attained  in 
the  following  instance,  which  was  reported  by  Morse,  in  the 
New  England  Medical  Monthly  for  May,  1898: 

"  Mr.  D.  Fargo,  aged  seventy-nine  years,  farmer  by  occupa- 
tion, was  attacked  with  gangrene  (senile)  in  the  left  foot. 
There  is  nothing  in  his  personal  or  family  history  worthy  of 
any  particular  mention  or  having  any  bearing  on  the  case. 
Patient,  while  cachectic-looking,  weak,  and  apparently  in  a  pre- 
carious state  of  health,  showed  no  other  organic  trouble  save 
the  heart — lungs,  stomach,  liver,  apparently,  being  normal. 
Urine  contains  some  earthy  phosphates,  but  no  albumin  or 
sugar.  Patient  noticed  his  trouble  first  in  August,  1897.  His 
family  physician  made  no  particular  diagnosis  and  on  that 
account  refused  treatment. 

"  Physical  examination  of  the  two  middle  toes,  which  were 
affected,  revealed  quite  a  deep  ulcerative  process,  involving 
also  the  adjacent  structures  of  the  dorsal  side  of  the  foot. 
Aside  from  the  general  sloughing  the  toes  were  practically 
dead.  Poultices,  cauterization,  and  antiseptics  proved  of  no 
avail.  Amputation  was  out  of  the  question,  on  account  of  the 
existing  heart  trouble  (mitral  insufficiency),  which  was  quite 
pronounced.  Then  decided  symptoms  of  blood  poisoning  set 
in.  Add  to  this  the  general  weakness,  due  to  disease  and  age, 


Angina  Pec  tor  is.  245 

and  it  was  evident  that  any  harsh  surgical  procedure  would 
almost  to  a  certainty  be  followed  by  shock  and  death. 

"  All  I  could  do  was  to  dissect  away  the  sloughing  tissue  and 
treat  the  wound  antiseptically.  The  condition  assumed  a  worse 
form,  the  leg  becoming  oedematous  from  the  knee  down  and 
hyperaesthetic.  Constitutional  treatment  was  prescribed,  but 
all  to  no  avail.  I  despaired  of  the  case  and  gave  an  unfavorable 
prognosis. 

"  Then  an  idea  struck  me — would  intense  dry  heat  not  alter 
the  local  condition?  I  had  previously  investigated  this  agent 
for  rheumatic  and  articular  affections,  and  immediately  ordered 
an  apparatus  from  Frank  S.  Betz.  On  arrival  of  the  apparatus 
the  limb  up  to  the  lower  third  of  the  thigh  was  wrapped  in  a 
towel  and  put  into  the  cylinder,  and  the  air  within  heated 
gradually  to  350°  F.  Two  treatments  a  day  were  given,  the 
temperature  reaching  later  400°  F.,  for  two  weeks.  Continu- 
ous observation  proved  a  decided  diminution  of  the  oedema, 
healing  by  granulation  of  the  sloughed  tissues,  and  improve- 
ment of  the  constitutional  septicaemic  symptoms.  Patient  was 
discharged  cured  in  two  weeks,  to  everybody's  surprise,  and  at 
the  time  of  writing,  is  working  on  his  farm." 

Angina  Pectoris. 

The  writer  has  treated  one  case  of  true  angina  pectoris  with 
dry  hot  air.  In  this  instance  the  cause  was  probably  calcareous 
degeneration  of  the  coronary  arteries  or  of  the  aorta.  When 
the  patient  came  under  treatment  he  was  unable  to  walk  half  a 
block  or  go  up  a  flight  of  stairs  without  provoking  an  attack, 
and  was  utterly  incapacitated  for  performing  his  ordinary  daily 
duties.  After  a  six  weeks'  course  of  body  treatments  he  had 
improved  to  such  an  extent  that  he  resumed  his  business  duties 
again.  He  would  sometimes  be  entirely  free  from  pain  for  two 
days  at  a  time,  and  when  it  did  obtain  it  was  not  severe  enough 
to  demand  opiates.  He  then  discontinued  his  treatment,  but  I 
still  see  him  occasionally  and  he  reports  himself  as  having 
slowly,  but  steadily,  improved. 

I  exercised  the  utmost  care  in  administering  the  treatments 
to  this  patient,  watching  the  heart  action  and  subjective  phe- 
nomena very  closely.  When  the  pulse  had  been  accelerated  to 
1 10  beats  per  minute  the  pain  would  always  begin  to  appear, 
and  if  the  treatment  was  continued  it  would  soon  rise  to  an 


246  Therapeutics  of  Dry  Hot  A  ir. 

excruciating  intensity,  compelling  the  patient  to  sit  up  in  the 
apparatus.  When  the  heat  was  turned  off,  however,  the  pain 
would  begin  to  subside  as  soon  as  the  pulse  got  below  1 10,  and 
I  soon  adopted  the  plan  of  turning  off  the  heat  as  soon  as  the 
pain  put  in  an- appearance,  without  any  reference  to  the  amount 
of  hyperthermia  induced.  No  alarming  symptoms  obtained  at 
any  time. 

It  would  seem,  from  its  power  of  influencing  atheroma  of  the 
general  arterial  system,  that  the  general  dry  hot  air  application 
would  be  of  use  in  treating  angina  pectoris  dependent  upon  this 
etiological  factor,  and  the  result  obtained  in  this  case  gives 
color  to  the  supposition.  In  view  of  the  almost  absolute  lack 
of  practical  experience  with  it  in  this  disease,  however,  and 
because  of  the  characteristic  effect  of  body  dry  hot  air  upon  the 
circulatory  system,  it  should  be  used  with  the  utmost  caution 
until  enough  experience  has  been  gathered  to  make  a  reliable 
judgment  possible. 

Pseudo-angina  is  most  frequently  dependent  upon  general 
nervous  debility  or  stomach  trouble  of  some  sort,  and  they  often 
go  hand  in  hand  etiologically.  Body  treatments  are  usually 
most  efficient  in  removing  both  cause  and  effect  in  combination 
with  other  appropriate  measures,  especially  static  electricity. 
The  writer  has  succeeded  in  curing  entirely  patients  who  had 
suffered  with  the  affection  for  five  years,  and  who  had  ex- 
hausted all  other  known  measures  of  therapeusis. 

La  Grippe. 

The  body  treatment,  applied  every  other  day  at  a  temperature 
of  350°  F.,  will  usually  completely  eradicate  the  disease  in  from 
four  to  eight  days.  The  first  seance  will  extinguish  the  pains 
entirely,  and  they  will  rarely  return;  the  bronchial  and  nasal 
symptoms  respond  at  once,  and  the  prostration  will  have  disap- 
peared inside  of  twenty-four  hours  to  such  an  extent  that  the 
patient  can  often  return  to  his  occupation  at  once.  Comfort  is 
secured  immediately,  and  the  slow  convalescence,  extending 
over  a  period  of  weeks  not  infrequently  under  other  methods  of 
treatment,  is  encountered  with  the  utmost  rarity  when  the 
affection  is  combated  with  dry  hot  air.  The  temperature  usually 


A  Icoholism.  247 

continues  slightly  elevated  for  a  day  or  two.  The  writer  can 
say,  with  a  conviction  born  of  personal  experience,  that  the 
field  of  therapeutics  offers  few  more  delightful  and  satisfactory 
possibilities  than  are  realized  by  the  treatment  of  influenza 
with  this  agent. 

Syphilis. 

A  few  patients  suffering  from  this  affection  have  been 
treated  with  this  agent  and  have  responded  well.  Corwin 
reports  a  case  of  multiple  syphilitic  arthritis  which  had  resisted 
other  therapeutical  measures  for  several  months  as  cured  in 
three  months  by  local  applications  in  combination  with  potas- 
sium iodide  internally.  Relief  of  pain  was  immediate  and 
permanent. 

The  body  treatment  is  the  application  that  should  be  used 
generally  in  this  disease,  and  mercury  or  potassium  iodide, 
according  to  indication,  should  be  thoroughly  administered  in 
combination  therewith.  The  general  tonic  effect  of  this  meas- 
ure, exerted  through  its  influence  upon  assimilation,  metabo- 
lism, and  elimination,  affords  good  grounds  for  the  hope  that 
its  addition  to  the  therapeutical  armamentarium  of  syphilis  will 
enable  us  to  shorten  materially  the  period  of  time  during  which 
it  is  now  necessary  to  keep  these  victims  under  treatment  in 
order  to  effect  a  cure. 

Alcoholism. 

A  glance  merely  at  the  physiological  action  of  body  dry  hot 
air  applications  will  demonstrate  their  exquisite  applicability  to 
ordinary  cases  of  alcoholism.  I  know  of  no  agent  that  will  so 
effectually  allay  the  nervous  symptoms,  produce  such  refresh- 
ing sleep,  and  place  the  patient  so  quickly  upon  his  feet. 

The  induction  of  the  phenomena  of  over-stimulation  is 
sometimes  very  easy  in  these  cases;  the  pulse  and  temperature 
go  up  very  quickly,  and  the  patient  must  be  watched  very 
closely  during  the  first  and  second  treatments.  A  fifteen-minute 
seance,  with  a  temperature  of  275°  F.,  is  sometimes  all  that  it 
is  judicious  to  administer,  and  the  writer  has  seen  a  pulse  of 
1 60  beats  per  minute  and  an  increase  of  3°  F.  in  the  body  tern- 


248  Therapeutics  of  Dry  Hot  Air. 

perature  follow  even  this  mild  application.  In  other  cases,  on 
the  other  hand,  the  seance  will  have  to  be  prolonged ;  the  idio- 
syncrasies of  each  individual  patient  will  have  to  govern  on 
these  points.  Regulation  of  the  ingesta  and  the  administration 
of  drugs  should  accompany  the  thermal  applications  as  indi- 
cated. 

The  radiant  heat  bath  has  been  extensively  and  successfully 
used  in  the  treatment  of  alcoholism  by  Crothers,  who  speaks  of 
it  in  most  favorable  terms.  It  promises  to  play  an  important 
part  in  the  future  therapy  of  this  condition. 

Gynecic  Affections. 

The  use  of  general  dry  hot  air  applications  in  acute  infec- 
tions of  the  adnexa  has  already  been  discussed  in  the  section 
upon  peritonitis,  and  it  is  only  necessary  to  say  further  that 
the  results  therein  suggested  have  been  confirmed  by  many 
operators,  both  in  this  country  and  abroad. 

Polano,  Dutzmann,  and  Burger,  of  Vienna,  Austria,  have 
secured  most  gratifying  results  in  some  cases  of  old  inflamma- 
tory processes  involving  the  female  pelvic  structures  of  from 
six  months'  to  nine  years'  standing,  as  regards  both  subjective 
and  objective  improvement.  They  consider  that  the  applica- 
tion affects  the  exudate  as  does  a  hot  cataplasm,  only  far  more 
energetically.  In  one  case  in  which  the  exudate  was  "  as  hard 
as  a  stone,"  the  resultant  softening  was  so  rapid  that  the  proper 
time  for  incision  passed  unnoticed  and  the  pus  ruptured  spon- 
taneously through  the  umbilicus  and  into  the  bladder. 

When  we  recall  that  the  human  organism  usually  rids  itself 
of  disease  processes  solely  by  an  accentuation  of  normal  meta- 
bolic processes,  the  logic  of  its  employment  in  conditions  such 
as  the  above  becomes  quite  clear;  it  is  undoubtedly  destined  to 
become  an  element  of  importance  in  the  management  of  gynecic 
inflammations. 

The  pain  of  dysmenorrhea  during  the  attack  can  ordinarily 
be  greatly  relieved  and  sometimes  entirely  removed  by  the  use 
of  the  body  treatment  at  the  time.  I  have  known  functional 
dysmenorrhea  of  long  standing  to  be  relieved  for  months  after 
a  course  of  body  treatments  given  for  some  other  affection. 


Malaria.  249 

When  the  trouble  is  due  to  structural  peculiarities  or  organic 
pathologies  of  the  pelvic  organs,  however,  nothing  of  course 
will  produce  a  permanent  cure  but  surgical  measures.  C. 
Stuart  Hutchinson,  during  the  course  of  an  address  to  the 
Central  District  Medical  Association  of  Iowa,  in  1900,  speaks 
of  body  dry  hot  air  treatments  in  this  condition  as  follows : 

"  Dysmenorrhea,  due  to  the  neuralgic  or  rheumatic  diathesis, 
inflammation  within  the  pelvis  and  parenchymatous  nephritis, 
may  be  relieved  by  increasing  the  elimination  through  the  skin 
and  bowels.  Repeated  baths  cause  functional  hypertrophy  of 
the  sweat-glands  and  eventually  enable  them  to  do  more  work. 
In  colds  the  congestion  of  the  nasal  mucous  membrane  can  be 
relieved  by  one  treatment.  Syphilitics  obtain  the  same  result 
as  from  the  Hot  Springs." 

Many  of  the  common  organic  and  structural,  as  well  as 
functional  causes  of  dysmenorrhea  can  ordinarily  be  removed 
more  efficiently  by  appropriate  applications  of  galvanic,  faradic, 
and  static  electricity  in  combination  with  dry  hot  air,  than  by 
any  other  measures,  surgical  or  medicinal.  It  must  be  admin- 
istered, however,  by  one  who  is  experienced  and  skillful  in 
this  particular  field,  and  good  judgment  must  be  exercised  as 
to  applicability  of  the  agent  to  the  individual  case. 

Malaria. 

The  paroxysm  of  malaria  is  one  situation  wherein  the  gen- 
eral dry  hot  air  application  will  not  produce  diaphoresis,  or 
benefit  of  any  kind  as  far  as  I  have  been  able  to  observe.  In 
those  occasional  obstinate  cases  wherein  the  paroxysm  persists 
in  returning  on  the  seventh  or  twenty-first  day,  however,  indi- 
cating a  low  condition  of  general  vitality  on  the  part  of  the 
patient,  a  few  of  these  treatments  will  render  good  service  in 
removing  the  general  debility,  whereupon  the  quinine  and 
tonics,  which  should  be  administered  synchronously  therewith, 
will  be  able  to  exercise  their  customary  power  over  this  disease 
and  produce  a  cure.  General  static  electrifications  also  are 
often  efficient  in  performing  the  same  service. 

Myositis. 

Most  commonly  encountered  during  the  course  of  the  acute 
infectious  diseases  and  as  the  result  of  traumatism.  The  local 


250  Therapeutics  of  Dry  Hot  Air. 

application  will'  usually  prove  most  satisfactory  for  its  man- 
agement, relieving  the  pain  and  spasmodic  tendencies  at  once. 
It  may  be  applied  every  twelve  hours  for  the  first  two  days  and 
once  daily  thereafter  until  the  muscle  has  regained  its  normal 
condition.  (For  illustration  of  its  action  see  pages  141  and 
142.) 

Osteomyelitis. 

Burwash  has  reported  two  cases  occurring  during  the  course 
of  typhoid  fever  as  cured  by  local  dry  hot  air  treatments.  He 
concludes  his  report  as  follows: 

"  Osteomyelitis  is  always  a  very  grave  disease ;  the  prog- 
nosis is  so  uncertain  in  any  case  that  the  physician  is  placed  in 
a  position  of  such  great  responsibility  that  he  feels  his  help- 
lessness, so  that  any  treatment  that  will  give  relief  to  this 
serious  disease  in  the  first  stages  is  eagerly  adopted.  The  early 
operative  treatment,  by  cutting  down  through  the  bone  and  into 
the  medullary  cavity,  to  remove  the  focus  of  inflammation  and 
disease,  is  often  the  only  hope  for  an  early  extirpation  of  the 
disease,  but  this  procedure  is  not  always  an  easy  matter  for 
the  surgeon  to  adopt  in  private  practice. 

"  The  hot  air  treatment  does  not  interfere  with  an  operation 
if  suppuration  develops,  while  it  may  be  the  means  of  com- 
pletely arresting  the  disease  in  the  first  stage,  and  thus  obviate 
the  necessity  of  an  operation." 

Periosteitis. 

When  caused  by  traumatism,  this  inflammation  can  fre- 
quently be  cured  by  the  local  application  alone,  but  the  writer 
has  seen  such  gratifying  results  follow  the  use  of  the  body 
treatment  that  he  prefers  the  latter  in  the  majority  of  instances. 
Some  cases  will  not  yield  until  the  body  treatment  has  come 
upon  the  scene.  The  aid  of  the  latter  should  always  be  invoked 
when  the  periosteitis  is  due  to  infection,  or  is  of  constitutional 
etiology. 

Muscular  Adhesions. 

Occasionally  met  with  after  fracture  of  the  long  bones, 
where  the  muscles  about  the  seat  of  the  injury  have  been 
lacerated  by  the  ends  of  the  fragments.  The  local  treatment  is 


Skin  Diseases.  251 

usually  all  that  is  necessary  for  removing  the  trouble,  but  the 
body  application  constitutes  a  powerful  reserve  when  the 
former  proves  inefficient.  Massage,  the  static  wave  current, 
and  galvanism  are  also  efficient  in  this  situation. 

Skin  Diseases. 

The  etiology  of  the  majority  of  the  pathological  processes 
which  commonly  affect  the  integument  would  lead  to  the  belief 
that  dry  hot  air  would  be  immediately  useful  in  their  treat- 
ment. Experience  demonstrates  that  this  is  occasionally  so, 
but  in  the  bulk  of  the  cases  so  far  treated,  especially  in  eczemas, 
marked  benefit  has  not  appeared  until  several  weeks  and  some- 
times months  after  the  agent  was  applied.  This  may  be 
looked  upon  as  an  indication  of  the  fact  that  in  these  cases 
impairment  of  the  trophic  nerve  centers  played  a  leading  part 
in  their  etiology,  hence  the  skin  disease  could  not  be  removed 
until  the  general  metabolic  functions  had  been  gotten  upon  an 
efficient  basis. 

Walsh  reports  an  interesting  case  of  eczema  of  both  hands 
of  long  standing.  One  hand  only  was  subjected  to  the  treat- 
ment, but  both  hands  got  well :  a  very  pretty  illustration  of  the 
reflex  influence  sometimes  exerted  by  this  agent.  The  evidence 
now  at  hand  indicates  that  both  body  and  local  applications,  but 
especially  the  body,  will  prove  to  be  of  considerable  assistance 
in  the  management  of  skin  diseases  in  the  future. 

Plumbism. 

The  following  is  reported  by  Corwin: 

"  Philip  B.,  Italian,  aged  forty-two.  Admitted  with  diag- 
nosis of  plumbism,  which  had  not  reached  paralytic  stage,  but 
muscles  crampy.  One  full  bath  relieved  above  conditions,  and 
after  four  baths  patient  was  discharged  well." 

The  administration  of  potassium  iodide  or  whatever  other 
drugs  are  indicated  should  accompany  the  dry  hot  air  treat- 
ments. 

Typhoid  Fever. 

Up  to  the  present  time  very  few  cases  of  typhoid  fever  have 
been  subjected  to  dry  hot  air  therapeusis,  hence  the  time  is  not 


COLLEGE 

l-K\  SlCl«U  •  CLUb 

L  C   :  It  ,.  £  ,.  fc  u  . 


252  Therapeutics  of  Dry  Hot  A  ir. 

ripe  for  judgment  as  to  its  influence  over  the  primary  infec- 
tion per  se;  but  it  is,  at  least,  very  useful  in  some  of  the  condi- 
tions that  obtain  during-  the  course  of  the  disease.  Myositis, 
neuritis,  and  neuralgia,  occurring  in  situations  other  than  about 
the  head,  are  readily  amenable  to  the  local  application,  and  the 
exhaustion,  always  threatening  and  frequently  eventuating  in 
dissolution,  which  sometimes  occurs  late  in  the  disease,  can  be 
controlled,  at  least  in  some  cases,  by  the  body  treatment.  The 
writer  has  seen  life  saved  under  these  conditions  when  the 
patient's  extremities  were  cold  and  clammy  nearly  to  the  trunk, 
the  fades  Hippocratica  present,  pulse  running  from  150  to  160 
beats  per  minute,  a  body  temperature  of  106°  F.  obtaining,  and 
the  sufferer  entirely  unconscious.  The  immediate  effect  of  the 
treatment  was  to  re-establish  the  circulation  in  the  extremities, 
bring  back  the  color  to  the  face,  and  to  strengthen  the  pulse 
and  heart-action  to  an  astonishing  degree.  The  body  tem- 
perature was  increased  half  a  degree  by  the  treatment,  but  it 
dropped  to  105°  F.,  within  two  hours,  and  the  patient  began  to 
improve  after  the  second  treatment,  given  twelve  hours  later, 
eventually  recovering  from  one  of  the  worst  attacks  of  typhoid 
that  I  have  ever  witnessed.  She  had,  altogether,  five  body 
treatments,  and  I  am  fully  persuaded  that  she  would  have  died 
had  they  not  been  administered. 

Another  very  pretty  instance  of  the  stimulating  influence  of 
this  agent  is  the  manner  in  which  it  overcomes  the  collapse 
which  sometimes  follows  cold  baths.  Cold  baths  exert  their 
beneficial  influence  through  a  stimulation  of  the  deep  spinal 
reflexes,  but  sometimes  the  nervous  system  is  too  much  over- 
whelmed by  typhotoxin  to  be  able  to  react,  and  depression 
results.  The  body  dry  hot  air  application  exerts  its  beneficial 
influence  in  the  same  way,  but  never  under  any  circumstances 
is  its  judicious,  skillful  administration  followed  by  secondary 
depression.  It  is  worthy  of  more  extensive  trial,  and  the  facts 
already  at  our  command  afford  grounds  for  the  hope  that  it  will 
prove  to  be  of  considerable  use  in  the  treatment  of  this  affec- 
tion in  the  future. 

The  phenomena  of  over-stimulation  are  easy  of  induction  in 
this  situation,  and  the  utmost  care  must  be  exercised  in  the 


•  i    ?,  r,  j 


Pains  of  Fiat-Foot.  253 

administration  of  the  agent  not  to  exceed  a  limit  appropriate  to 
the  individual  case.  The  pulse  and  body  temperature  are 
valueless  as  guides  to  the  duration  and  intensity  of  the  treat- 
ment, and  the  general  response  on  the  part  of  the  patient  must 
govern.  The  art  which  is  the  result  of  experience  is  again 
invaluable  in  this  connection. 

Pains  of  Fiat-Foot. 

The  permanent  removal  of  such  pains  cannot  be  effected  by 
any  measure  save  proper  support  of  the  sagging  arch,  but  in 
hastening  adaptation  of  the  supported  foot  to  its  new  conditions 
and  in  relieving  the  pain  temporarily,  local  dry  hot  air  treat- 
ments are  very  useful.  They  may  be  applied  every  day  or  two 
with  the  technique  usual  to  the  procedure.  Peckham  says,  in 
the  Philadelphia  Medical  Journal  for  August  10,  1901,  "  There 
are  many  cases  of  flat  feet  which  still  continue  to  be  painful, 
even  after  all  the  measures  referred  to  (mechanical  support 
and  gymnastics)  have  been  faithfully  carried  out,  and  these  are 
the  cases  which  demand  something  in  addition  to  the  rou- 
tine treatment.  A  foot  that  has  borne  weight  all  day  is  hot, 
tender,  and  painful,  and  all  motion  is  limited.  A  few  minutes 
of  massage  is  extremely  soothing  to  such  a  foot.  The  pain  is 
relieved,  the  foot  is  rendered  much  more  flexible,  and  the  gym- 
nastic work  can  then  be  done  with  comfort.  If  heat  is  applied 
just  before  the  massage,  the  result  is  even  better,  and  heat 
alone,  without  massage,  is  of  the  greatest  value  just  preceding 
the  gymnastic  exercises.  In  hospital  cases  I  have  used  the  hot 
air  oven  in  almost  every  painful  case  with  much  benefit.  It 
has  also  been  of  great  value  in  cases  of  contracted  Achilles 
tendons,  where  gradual  stretching  was  done,  the  tendon  yield- 
ing much  more  and  much  easier  after  an  hour  in  the  hot 
oven." 

The  various  static  modalities,  the  continuous  current,  and 
mechanical  vibratory  stimulation  are  also  very  useful  in  this 
situation,  but  have  not  proven  to  be  as  satisfactory  as  dry  hot 
air  in  the  writer's  experience.  We  usually  apply  these  modali- 
ties in  connection  with  dry  hot  air.  however. 


254  Therapeutics  of  Dry  Hot  Air. 

Obesity. 

Body  treatments  have  been  lauded  as  a  remedy  for  obesity, 
but  the  writer  has  never  seen  them  reduce  weight  markedly  or 
permanently,  unless  a  regulation  of  diet  accompanied  their 
administration.  "  He  has  not  yet  been  able  to  convince  himself 
that  dry  hot  air  increased  the  effect  obtainable  with  dietary 
regulation  and  exercise  when  used  without  this  agent,  and  is 
unwilling,  at  the  present  time,  to  speak  in  its  favor  as  a  remedy 
for  this  condition. 


CHAPTER   XII. 
FIELDS    OF    FUTURE    RESEARCH. 

Dry  hot  air  therapeusis  is  as  yet  in  its  infancy,  but  its 
physiological  action  and  what  has  been  demonstrated  in  the 
way  of  clinical  results  up  to  the  present  time  indicate  the  lines 
upon  which  future  experimental  work  may  be  conducted. 
Enough  has  already  been  accomplished  to  establish  the  agent 
upon  a  sound  basis  as  a  permanent  element  in  our  therapeutical 
armamentarium.  Its  powers  are  exhibited  in  fields  but  ineffi- 
ciently covered  by  other  measures,  and  the  character  of  its 
beneficial  activity  is  such  as  to  indicate  an  extended  scope  of 
usefulness  in  the  future.  In  the  fields  of  future  possibilities 
may  be  mentioned  the  following  ailments : 

Erysipelas. — In  Bulgaria  it  is  a  common  domestic  practice 
to  treat  erysipelas  by  holding  a  red-hot  iron  or  a  bare  flame 
close  enough  to  the  part  affected  to  scorch  the  integument, 
producing  a  burn  of  the  first  degree.  Tregubow  has  adopted 
this  treatment,  using  the  flame  of  a  spirit  lamp  or  a  bit  of 
burning  cotton  which  had  been  previously  dipped  in  alcohol, 
as  the  cauterizing  instrument,  and  reports  gratifying  results. 
This  fact  would  suggest  the  use  of  dry  hot  air  applications  in 
this  disease,  and  the  marked  benefits  which  result  from  their 
use  in  other  local  septic  infections  afford  reasonable  grounds 
for  hoping  that  they  may  prove  useful  here.  The  principles  of 
application  and  technique  would  be  the  same  as  those  described 
in  the  section  upon  local  septic  infection. 

Tetanus. — This  is  a  local  infection  with  micro-organisms 
in  which  death  results  from  the  action  of  toxins  circulating  in 
the  blood  which  emanate  directly  from  the  germ  colonies.  It 
is  entirely  analogous  to  ordinary  septic  infection,  and  in  view  of 
the  gratifying  influence  which  is  exerted  by  thermotherapy  in 
the  latter  accident,  this  agent  would  seem  to  be  exquisitely  ap- 

255 


256  Therapeutics  of  Dry  Hot  Air. 

plicable  here.  As  far  as  I  know  no  cases  have  as  yet  been 
so  treated,  but  in  view  of  the  inadequacy  of  the  current  methods 
of  management,  this  affection  would  seem  to  offer  a  promising 
field  for  investigation. 

Lupus. — Werther  and  Lichtwitz  have  reported  good  results 
from  the  use  of  dry  hot  air  in  the  treatment  of  lupus.  They 
employ  a  temperature  of  from  150°  F.  to  250°  F.  Werther  has 
found  the  treatment  to  be  very  painful,  and  administers  a 
general  anaesthetic,  but  the  experience  of  Lichtwitz  has  been 
diametrically  opposed  to  this.  The  physiological  action  of  the 
agent,  and  the  results  of  its  use  in  other  infections,  suggest  its 
application  to  cases  of  this  disease.  The  remarkably  favorable 
results  obtainable  with  radiotherapy  in  this  connection,  how- 
ever, bid  fair  to  displace,  for  a  time  at  least,  almost  all  other 
methods  of  dealing  with  the  affection,  and  dry  hot  air  will 
probably  not  be  investigated  in  this  connection  further  at 
present. 

Surgical  Shock. — One  of  the  means  most  depended  upon 
for  the  relief  of  this  condition  is  the  application  of  heat  by 
means  of  the  hot  pack,  hot-water  bottles  placed  about  the  body, 
etc.  By  using  a  body  dry  hot  air  apparatus,  heat  can  be  applied 
not  only  much  more  easily,  but  the  degree  of  elevation  can  be 
maintained  with  great  uniformity,  and  the  application  can  be 
made  intense  enough  to  produce  a  degree  of  stimulation  which, 
as  has  already  been  stated,  is  not  surpassed,  and  probably  not 
equaled,  by  any  other  measure  now  known.  In  addition  to 
this,  no  vicious  reaction  is  to  be  feared,  and  it  is  probable  that 
the  body  apparatus  will  be  as  familiar  an  adjunct  to  the  sur- 
gical operating  room  of  the  near  future  as  is  the  operating  table 
to-day. 

Hodgkin's  Disease. — The  increase  of  the  number  of  red 
blood  cells  dependent  upon  the  application  of  the  body  treat- 
ment, together  with  its  powerfully  stimulant  influence  upon  cell 
activity  and  vitality,  would  seem  to  rationally  indicate  its  use 
in  this  affection.  Color  is  further  lent  to  this  supposition  by  the 
very  satisfactory  manner  in  which  dry  hot  air  disposes  of 
localized  cultures  of  the  tubercle  bacillus  in  other  situations, 
as  in  joint  tuberculosis.  Appropriate  drug  tonics,  general  X- 


Fields  of  Future  Research.  257 

ray  applications,  etc.,  should,  of  course,  accompany  the  thermal 
agent. 

Multiple  Neuritis. — Multiple  neuritis  is  dependent  upon  a 
variety  of  causes,  many  of  which  exhibit  exquisite  possibilities 
for  the  body  treatment,  in  combination  with  other  appropriate 
measures,  and  the  affection  is  usually  troublesome  enough,  both 
as  regards  chronicity  and  suffering,  to  assure  a  hearty  welcome 
for  any  agent  that  will  increase  our  present  ability  to  overcome 
the  trouble. 

Tabes  Dorsalis. — Tabes  dorsalis  and  other  nervous  diseases, 
characterized  by  degenerative  tendencies,  offer  a  field  for 
apparently  fruitful  investigation,  especially  in  their  early  stages. 
It  has  already  been  demonstrated  that  skillfully  applied,  appro- 
priate, static  electrical  modalities  will  apparently  cure  some 
cases  of  tabes  in  its  early  stages.  Dry  hot  air  acts  in  much  the 
same  way  as  electricity,  but  much  more  profoundly  and  per- 
manently in  some  conditions,  and  diseases  of  this  nature  would 
seem  to  constitute  a  good  field  for  investigation. 

Diabetes  Mellitus. — Diabetes  mellitus  is  a  disease  one  of  the 
most  prominent  characteristics  of  which  is  sub-oxidation.  This, 
as  well  as  most  of  the  other  symptomatic  phenomena,  consti- 
tutes an  exquisite  indication  for  the  induction  of  the  effects 
of  thermotherapy  upon  the  trophic  and  metabolic  functions. 

Mental  Aberrations. — Some  mental  diseases,  as  paresis, 
which  frequently  have  their  origin  in  constitutional  degenera- 
tions or  excessive  nerve  strain,  ought  to  be  amenable  in  some 
degree  to  thermotherapy,  at  least  in  their  early  stages.  The 
writer  has  seen  one  case  of  commencing  paresis  which  indicates 
that  a  curative  result  may  not  be  impossible  of  attainment,  and 
he  hopes  to  see  investigations  on  this  line  instituted  in  the  in- 
sane asylums  in  the  future.  Time  thus  spent  would  not 
be  wasted  even  if  no  benefit  in  the  mental  state  followed,  as  the 
general  physical  condition  of  the  patients  thus  treated  would 
be  improved. 

The  Infectious  Diseases. — In  typhoid  fever  the  employment 
of  the  body  treatment  has  already  been  alluded  to,  and  its  effects 
in  this  ailment  would  suggest  that  it  might  be  useful  in  other 
diseases  of  this  class.  The  writer  has  applied  it  to  one  case 


258  Therapeutics  of  Dry  Hot  A  ir. 

of  measles,  occurring  in  a  man  thirty-eight  years  old,  with 
most  gratifying  results.  The  rash  developed  with  great  rapid- 
ity and  profusion  and  disappeared  entirely,  together  with  the 
other  symptoms  of  the  disease,  which  had  existed  with  a  moder- 
ate degree  of  severity,  in  four  days  after  the  treatment  was 
instituted,  when  the  patient  was  discharged  cured. 

This  is  an  encouraging  showing  when  we  consider  the  sever- 
ity of  an  ordinary  case  of  measles  occurring  in  adult  life.  The 
great  profuseness  of  the  rash,  and  the  rapidity  with  which  it 
developed  in  this  case,  would  indicate  that  influence  upon  the 
function  of  elimination  played  a  large  part  in  the  production 
of  the  beneficial  results. 

Cerebro- Spinal  Meningitis  ("Spotted  Fever"). — A  dis- 
ease of  microbic  etiology  which  has  been  increasingly  prevalent 
during  the  last  year.  The  writer  has  had  no  cases  under  treat- 
ment, but  the  etiology,  pathology,  and  clinical  phenomena 
strongly  suggest  that  the  characteristic  influences  of  the  body 
dry  hot  air  application  might  profitably  be  invoked  in  a 
remedial  capacity.  The  mortality  percentage  is  so  high  under 
the  management  at  present  in  vogue  that  careful  and  thorough 
investigation  of  the  powers  of  any  measure  that  promised  to 
exhibit  helpful  properties,  would  seem  to  be  justifiable  and 
desirable.  That  the  general  dry  hot  air  application  holds  forth 
such  promise  is  evident  from  a  study  of  its  physiological 
action. 

Other  local  and  general  disease  conditions  might  be  men- 
tioned under  this  chapter  heading,  but  the  above  are  sufficient 
to  indicate  the  general  lines  along  which  future  investigations 
may  be  expected  to  develop  results,  and  the  belief  is  held  by 
those  most  familiar  with  this  therapeutic  agent  that  the  prose- 
cution of  such  investigations  will  eventuate  in  the  acquisition 
of  helpful  knowledge. 


INDEX 


Abdomen,  local  application  to,  57 
Action,  physiological,  of  Body  Ap- 
plication, 25 
local  application,  28,  31 
Alcoholism,  247 
Analogies,  physiological,  32 
Anchylosis,  bony,  in  arthritis  de- 

formans,  187 
Treatment  of,  197 

Fibrous,  241 
Angina  pectoris,  245 
Apparatus,  i 
Different  forms  of,  i 
For  applying  dry  hot  air  to  open 

cavities,  18 
Body,  essentials  in  construction 

of,  2 

Structural  modification  of,  2 
General  local,  essentials  in  con- 
struction of,  12 
Knee,  13 
location  of,  18 
Appendicitis,  201 
Applicability,  clinical,  of  dry  hot 

air,  31 
Arc  light,  electric,  23 

In  nervous  debility  and  exhaus- 
tion, 237 

Arthritis  deformans,  169 
Atheroma,  88,  185,  189 

B 

Beck  on  Otitis,  232 
Betz,    F.   S.,  &   Co.,   of   Chicago, 

111.,  i 
Blood  poisoning.     See  local  septic 

infection 

Body  dry  hot  air  application 
Effect  upon  blood  composition 

of,  25 
Effect  upon  body  temperature 

of,  25 

Capillary  circulation  of,  26 
Pulse  of,  25 
Respiration  of,  25 
Urea,  excretion  of,  26 
Urinary  secretion  of,  26 


In  alcoholism,  247 

angina  pectoris,  245 

arthritis  deformans,  182,  189 

Bright's   disease.       See     Ne- 
phritis 

cholelithiasis,  242 

chronic  bronchitis,  241 

diabetes  mellitus,  257 

dysmenorrhea,  248 

fibrous  anchylosis,  241 

gall   stones.     See    Cholelithi- 
asis 

Hodgkin's  disease,  256 

la  grippe,  246 

lithaemia,  226 

local  septic  infection,  121,  127 

mental  diseases,  257 

multiple  neuritis,  257 

muscular  adhesions,  250 

myalgia,  230 

myositis,  249 

nephritis,  157,  166 

nervous  debility,. 237 

neuralgia,  229 

neuritis,  217 

obesity,  254 

paresis      See  Mental  Diseases 

periosteitis,  250 

peritonitis,  201,  206 

pleuritis,  212 

plumbism,  251 

pneumonia,  138,  144 

pulmonary  tuberculosis,  238 

rheumatism,  105,  112 

skin  diseases,  251 

surgical  shock,  256 

synovitis,  213,  216 

syphilis,  247 

tabes  dorsalis,  257 

the  infectious  diseases,  257 

typhoid  fever,  252 

weak  heart,  25,  88,  252 

varicose  ulcers,  231 

valvular  heart  lesions,  88 
Physiological  action  of,  25 
Technique  of,  76 

Boston  Medical  and  Surgical  Jour- 
nal, 187 


259 


260 


Index. 


Burdick,  Dr.  G.,  240 

Burger  on  gynecic  affections,  248 

Burns,  87 

Burwash,  H.  J.,  201,  250 

Busc  on  radiology,  101 


Cerebro-Spinal  Meningitis,  258 
Chair,  special  for  shoulder  treat- 
ment, 17 

Cheney,  Dr.  A.  S.,  123 
Chest-wall,   local   application    to, 

57 

Cholelithiasis,  242 
Chronic  bronchitis,  241 
Cleaves,  Dr.  M.  A.,  24 
Centra-indications  to   thermaero- 

therapy,  87 

Corwin,  R.  W.,  213,  247,  251 
Crothers,  Dr.  T.  D.,  24,  248 

D 

D'Arsonvalization.     See  Electric- 
ity 

Diabetes  mellitus,  257 
Diet 
In  alcoholism,  248 

Arthritis  deformans,  133 

Bright's    disease.       See     Ne- 
phritis 

cholelithiasis,  243 

lithaemia,  226 

local  septic  infection,  128 

nephritis,  167 

nervous  debility,  237 

neuritis,  218 

obesity,  254 

rheumatism,  113 
Dropsy,  160,  162,  165 
Dutzmann  on  gynecic  affections, 

248 
Dysmenorrhea,  248 

E 

Electricity 

In  arthritis  deformans,  190 
Bright's    disease.       See     Ne- 
phritis 

cholelithiasis,  242 
chronic  bronchitis,  241 
fibrous  anchylosis,  241 
gall   stones.     See    Cholelithi- 
asis 

lithaemia,  227 
local  septic  infection,  128 
muscular  adhesions,  250 
myalgia,  230 
nephritis,  167 


nervous  debility,  237 
neuralgia,  230 
neuritis,  218 
peritonitis,  211 
pulmonary  tuberculosis,  240 
rheumatism,  115 
sciatica,  222 
sprains,  95 
synovitis,  215 
tabes  dorsalis,  257 
uterine  pathology,  249 
varicose  ulcers,  231 
Erysipelas,  255 


Faradism.     See  Electricity 
Fibrous  anchylosis,  241 
Fibrous   adhesion.      See    Fibrous 
anchylosis  and  Muscular  ad- 
hesion 

In  rheumatism,  98 
Fire-proof  cloth  fittings,  15 
Flat-foot,  105 

Pains  of,  253 

Future  possibilities  of  dry  hot  air 
therapeutics,  255 


Gall  stones.     See  Cholelithiasis 
Galvanism.     See  Electricity 
Gangrene,  244 

Geyser,  Dr.  Albert  C.,  163,  165 
Gonorrheal  arthritis.     See  Syno- 
vitis 

Gout,  227 
Grubbe,  Dr.  Emil,  240 

H 

Halberstaedter  on  radiology,  101 

Hartley,  Dr.  Frank,  125 

Heart  failure  in  pneumonia,  148 

Heart,  influence  of  body  applica- 
tion upon,  25,  88,  252 

Heart  lesions,  88 

High    frequency     current.       See 
Electricity 

Hip  treatment,  57 

Hodgkin's  disease,  256 

Hopkin's  heater,  19 
Technique  recommended  for  use 
with,  75 

Hopkins  on  Otitis,  232 

Hutchinson,  C.  S.,  248 

Hydrotherapy  compared  with  dry 

hot  air,  24,  32,  37 
In  lithaemia,  227 
Sprains,  95 


Index. 


261 


I 

Incandescent  light,  23 
In  alcoholism,  248 
Nervous  debility  and  exhaus- 
tion, 237 

Infection.     See  local  septic  infec- 
tion 

Infectious  diseases,  257 
Intermissions  in  treatment,  86 

K 

King  on  radiology,  101 
Kinnear,  Beverly  C.,  137 
Knee  apparatus,  special,  13,  44 
Knee,  local  application  to,  44 
Kny-Scheerer  Co.,  of  New  York,  \ 


La  grippe,  246 

Lead  poisoning.      See  Plumbism 

Lewis,  Dr.  B.  S.,  143 

Lichtwitz,  L.,  256 

Lithaemia,  224 

Local  dry  hot  air  application 

in   arthritis    deformans,    169, 
188 

chronic  bronchitis,  241 

erysipelas,  255 

fibrous  anchylosis,  241 

local  septic  infection,  119,  126 

lupus,  256 

muscular  adhesions,  250 

myositis,  249 

nephritis,  150 

neuralgia,  229 

neuritis,  217 

osteomyelitis,  250 

periosteitis,  250 

peritonitis,  206 

pleuritis,  212 

pneumonia,  144 

pulmonary  tuberculosis,  239 

rheumatism,  in 

skin  diseases,  251 

synovitis,  215 

syphilis,  247 

varicose  ulcers,  231 
Physiological  action  of,  28,  31 
Local  septic  infection,  117 
Location  of  apparatus,  18 
Lumbar  region,  local  application 

to,  57 

Lung,  local  application  to,  57 
Lupus,  256 

M 

Malaria,  97,  249 
Marcoe,  Dr.  Francis,  125 


Massage,  32 

In  arthritis  deformans,  193 

rheumatism,  112 

sprains,  95 

McNeil,  Dr.  Rollin,  141,  143 
McLagon,  on  rheumatism,  97 
Measles,  258 

Mechanical  vibratory  stimulation 
in 

Arthritis  deformans,  197 

Bright's  disease,  164,  165 

Rheumatism,  116 

Sciatica,  223 

Sprains,  95 
Mental  diseases,  257 
Morse,  on  gangrene,  244 
Morton  wave  current.     See  Elec- 
tricity 

Multiple  neuritis,  257 
Muscular  adhesions,  250 
Myalgia,  230 
Myositis,  144,  249 


Nephritis,  150 

Nerve  stretching  in  sciatica,  224 

Nervous  debility,  236 

Nervous  exhaustion.  See  Nervous 
Debility 

Neuralgia,  228 

Neurasthenia.  See  Nervous  De- 
bility 

Neuritis,  217 

New  England  Medical  Monthly, 
224 

New  York  Medical  Journal,  131. 
202 

O 

Oaks  on  Otitis,  232 
Obesity,  254 
CEdema.     See  Dropsy 
Operative  interference  in 

appendicitis.  201 

local  septic  infection,  128 

neuralgia,  228 

osteomyelitis,  250 

peritonitis,  201 

peritonitis,  tuberculous,  202 

pleuritis.  212,  213 

sciatica.  224 

tuberculous  synovitis,  214 
Osteomyelitis,  250 
Otitis,  232 
Ozone  Inhalations  in 

chronic  bronchitis,  241 

pneumonia,  149 

pulmonary  tuberculosis,  240 


262 


Index. 


Periosteitis,  250 
Peritonitis,  200 
Permanence  of  results,  40 
Physiological  action  of 

body  application,  25 

local  application,  28 
Pleuritis,  311 
Plumbism,  251 
Pneumonia,  130 

Polano  on  gynecic  affections,  248 
Pseudo-angina  pectoris,  246 
Pulmonary  tuberculosis,  238 

R 

Randall,  Dr.  W.  S.,  157,  160 
Results,  permanence  of,  40 
Rheumatism,  97 

Chronic,  109.  in,  116 
Ringer  on  burn  prevention,  74,  82 
Rudis-Jicinsky,  Dr.  J.,  240 

S 

Salicylic  acid  and  rheumatism,  101 
And  arthritis  deformans,  194 

Salpingitis,  201,  248 

Schloss  on  Otitis,  232 

Schreiber,  J.,  14 

Sciatica,  219 

Septic  infection.     See  Local  Sep- 
tic Infection 

Shoulder,  local  application  to,  56 

Shoulder  treatment,  special  chair 
for,  17 

Skiff,  Dr.  Walter  C.,  143 

Skin  diseases,  251 

Smith,  Andrew  H.,  131 

Spotted      P'ever.       See    Cerebro- 
Spinal  Meningitis 

Sprague  apparatus,  i 

Sprains,  92 

Stimulation,  excessive,  80 
Mechanical  vibratory  in 
Arthritis  deformans,  197 
Bright's  disease,  164,  165 
Rheumatism,  116 
Sciatica,  223 
Sprains,  95 

Stretch,  Dr  James,  109 

Surgery.     See  Operative  Interfer- 
ence 

Surgical  shock,  256 

Sverhevsky  on  Otitis,  232 

Synovitis,  213 

Syphilis,  247 


Tabes  dorsalis,  257 


Technique,  42 
Of  body  application,  76 

in  alcoholism,  247 

angina  pectoris,  245         • 

arthritis  deformans,  189 

Bright's    disease.       See     Ne- 
phritis 

la  grippe,  246 

lithaemia,  227 

local  septic  infection,  127 

nephritis,  166 

peritonitis,  206 

pleuritis,  212 

pneumonia,  147 

rheumatism,  112 

sprains,  95 

typhoid  fever,  252 
Of  local  application,  43 

in  local  septic  infection,  126 

peritonitis,  206 

pleuritis,  212 

pneumonia,  144 

rheumatism,  in 

sprains,  94 
Knee  application,  44 
Pulse  and  temperature  as  guides 

in,  80 

Tetanus,  251; 

Tregubow  on  erysipelas,  255 
Tuberculosis  of  knee  joint,  214 

Pulmonalis,  238 
Typhoid  fever,  251 

U 

Uric  acid  in  arthritis  deformans, 
172 

V 

Varicose  ulcers,  231 
Vibration.     See  Vibratory  Stimu- 
lation 

W 

Walsh,  J.,  29,  251 
Wave  current      See  Electricity 
Werther  on  lupus,  256 
Wood  on  dry  hot  air  in  joint  dis- 
eases, 99 

X 

X-light  in 

arthritis  deformans,  178 
intra  -  abdominal     malignant 

growths,  200 
lupus,  256 

pulmonary  tuberculosis,  240 
tuberculosis  of  joints,  217 


DATE  DUE 


GAYLORD 


PRINTED  IN  U   S    A 


000510232 


WBU65 
S628t 
1907 

Skinner,  Clarence  Edward. 
Therapeutics  of  dry  hot  air 


WBU65 
S628t 

1907 

Skinner,  Clarence  Edvard. 
Therapeutics  of  dry  hot  air 


